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Reduction in IBS Rates Using Rome IV Criteria

Vanessa M. Shami, MD, FASGE, reviewing Olafur S, et al. Gastroenterology 2020 Jan 6. 

Functional bowel disorders (FBDs) are common, and the diagnosis is clinical. This study utilized a multinational survey from the United States, Canada, and the United Kingdom to assess the prevalence and demographics of FBDs. The survey included questions from the Rome III and IV diagnostic criteria questionnaires for irritable bowel syndrome (IBS) and the SF-8 quality-of-life questionnaire. Individuals were excluded if they reported a history of organic diseases, including celiac disease, inflammatory bowel disease, GI cancer, peptic ulcer disease, or diverticulitis.

There were 5931 valid responders (49.2% female; mean age, 47.4 years; range, 18-92 years), with similar results among all 3 countries. Based on the responses, more than 1 in 4 adults met criteria for Rome IV FBDs (28.6%-31.7%), with findings including 4.4% to 4.8% for IBS, 7.9% to 8.6% for functional constipation (FC), 3.6% to 5.3% for functional diarrhea (FD), 2.0% to 3.9% for functional bloating or distention, 1.1% to 1.9% for opioid-induced constipation, and 7.5% to 10.0% for unspecified FBDs.

Comment:
The most notable finding from this analysis is that IBS rates were reduced by half when using stricter Rome IV criteria, which excludes “discomfort” (used in Rome III criteria) in the verbiage describing symptoms. With the shift away from an IBS diagnosis, both FD (0.9%-4.7% in the overall sample) and FC rates increased. Interestingly, FC was more common in a younger population compared to older groups. Future studies will need to delineate how changes in Rome IV classification influence workup or treatment options for patients with FBDs.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Vanessa M. Shami, MD, FASGE

Citation(s):

Palsson OS, Whitehead W, Törnblom H, Sperber AD, Simren M. Prevalence of Rome IV functional bowel disorders among adults in the United States, Canada, and the United Kingdom. Gastroenterology 2020 Jan 6. (Epub ahead of print) (https://doi.org/10.1053/j.gastro.2019.12.021)

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