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BACKGROUND: Population-based studies of the prevalence of all functional gastrointestinal disorders (FGID) using the Rome II criteria are lacking. It is also not certain whether subjects who meet the Rome II criteria for an FGID are different in terms of demographic and psychological characteristics from those subjects meeting exclusively the more restrictive Rome I criteria. AIM: To determine whether using the more restrictive Rome I criteria would result in a more biologically determined group of FGID than when the Rome II is applied. METHODS: Subjects included individuals aged 18 years and older (n = 1,225) from the Penrith population who were initially surveyed with the Penrith District Health Survey in 1997. Subjects were sent a self-report questionnaire that contained items on gastrointestinal symptoms applying the Rome II criteria. Subjects were also assessed on psychological and personality factors and on physical and mental functioning. RESULTS: A total of 36.1% (n = 275) of respondents was diagnosed with an FGID according to Rome II criteria. The five most prevalent FGID were functional heartburn (10.4%), irritable bowel syndrome (8.9%), functional incontinence (7.6%), proctalgia fugax (6.5%) and functional chest pain (5.1%). Subjects meeting Rome II only criteria for FGID scored significantly higher on measures of psychological caseness and emotionality than Rome I only subjects, and these were independently associated with meeting Rome I only versus Rome II only criteria for FGID. CONCLUSION: The Rome II criteria FGID are common and do not appear to identify a vastly different group of FGID sufferers compared with the earlier Rome I criteria.
The Rome II criteria and questionnaires developed to identify functional gastrointestinal disorders have not been evaluated. Our objectives were to determine the prevalence of functional gastrointestinal disorders in Canada, compare our results with data from other published studies, assess concordance of Rome I and Rome II criteria for irritable bowel syndrome, and suggest improvements in the Rome II questionnaire. An independent research firm was employed to conduct a random digit dial national survey, inviting household members > or = 18 years of age to participate in a study examining personal health issues. Subjects recruited by telephone, who agreed to participate, were mailed a questionnaire, and the data were retrieved by a follow-up phone call. The Rome II questionnaire and algorithms were used and where possible Rome I algorithms were also applied. At least one functional gastrointestinal disorder occurred in 61.7% of 1149 respondents (65.6% female versus 57.6% male; P < 0.05). The most prevalent were the functional bowel disorders at 41.6% followed by esophageal disorders at 28.9%. Irritable bowel syndrome prevalence by Rome II and I criteria were 12.1% and 13.5%, respectively (kappa = 0.76). Because the Rome II criteria have added exclusion items that are not present in the Rome I criteria, the prevalence of esophageal, gastroduodenal, and anorectal disorders is lower than the figures from a US market survey. In conclusion, functional gastrointestinal disorders are highly prevalent in Canada, with a significantly higher rate in women. There is substantial agreement between Rome I and Rome II criteria for irritable bowel syndrome. Rome criteria and questionnaire remain works in progress.
BACKGROUND: Irritable bowel syndrome (IBS) prevalence estimates are essential for measuring the importance of the problem and the burden of the illness. However, IBS diagnosis is based on clinical criteria which have changed over time. The aim of this study was to assess how the use of different diagnostic criteria influences estimated IBS prevalence and, in particular, to compare how this prevalence varies using the new Rome II criteria and previous diagnostic criteria. METHODS: An epidemiological survey was conducted in the general population using personal interviews in a home setting. Two thousand individuals stratified by gender, age, social class and geographic location were randomly selected from the general population of Spain. Participants were classified as 'potential IBS subjects' (n = 281) or 'non-potential IBS subjects' (n = 1719) as a result of their response to a screening question regarding the presence of abdominal pain, constipation or diarrhoea. Thus, we estimated IBS prevalence according to the following diagnostic criteria: Manning, Rome I, Rome II, Drossman, Talley and Kay & Jorgensen. RESULTS: Prevalences of IBS according to the Manning and Rome I criteria were 10.3% and 12.1%, respectively. These were higher than the prevalences obtained with the other criteria used, which varied from 2.1% to 4.9%. IBS was more prevalent in females than males irrespective of the criteria used (the female:male ratio ranged from 2.33 to 4.33). Subjects who fulfilled the Rome II, Drossman, Talley or Kay & Jorgensen criteria also fulfilled the Rome I and Manning criteria. However, between 44% and 80% of subjects who fulfilled the Rome I or Manning criteria did not fulfil the more stringent diagnostic criteria. CONCLUSIONS: The prevalence of IBS varies enormously depending on the diagnostic criteria employed. Criteria based on the frequency of symptoms, such as the Rome II criteria, produce much lower prevalence values compared to criteria based solely on the presence of symptoms. In fact, more than two-thirds of subjects who fulfilled the Rome I criteria would not have been diagnosed with IBS if Rome II criteria had been employed.
OBJECTIVES: It has been suggested that the variation in the prevalence of irritable bowel syndrome (IBS) may be due to the application of different diagnostic criteria. New criteria for IBS have been proposed (Rome II). It is unknown whether persons meeting different criteria for IBS have similar psychological and symptom features. The aim of this study was to measure the prevalence of IBS according to Manning and Rome definitions of IBS and to evaluate the clinical and psychological differences between diagnostic categories. METHODS: A total of 4500 randomly selected subjects, with equal numbers of male and female subjects aged > or = 18 yr and representative of the Australian population, took part in this study. Subjects were mailed a questionnaire (response rate, 72%). Characteristics measured were gastrointestinal symptoms over the past 12 months, neuroticism and extroversion (Eysenck Personality Questionnaire), anxiety and depression (Delusions-Symptoms-States Inventory), mental and physical functioning (SF-12), and somatic distress (Sphere). RESULTS: The prevalence for IBS according to Manning, Rome I, and Rome II was 13.6% (95% confidence interval [CI] = 3.5-5.1%), 4.4% (CI 6.0-7.8%), and 6.9% (CI 12.3-14.8%), respectively [corrected]. Only 12 persons with Rome I did not also meet Rome II criteria; 196 persons with Manning criteria did not meet Rome II cut-offs. Having IBS regardless of which criteria were used was significantly associated with psychological morbidity, but psychological factors were not important in discriminating between diagnostic categories. However, pain and bowel habit severity independently discriminated between diagnostic groups. CONCLUSIONS: IBS is a relatively common disorder in the community. The new Rome II criteria may be unnecessarily restrictive in practice.
OBJECTIVE: Until now, the epidemiology of functional dyspepsia (FD) and its social impact on Asians have been rarely studied. The aims of this study were to determine the prevalence, social impact, and health-seeking behaviors of FD in an apparently healthy Chinese population in Taiwan. MATERIAL AND METHODS: Based on the questionnaire provided by the Rome II working team, a survey was administered to a Taiwanese population receiving paid physical check-up (n = 2865). Esophagoduodenoscopy was performed in each subject to exclude organic dyspepsia. Finally, diagnoses of functional gastrointestinal disorders were obtained by means of a computer-generated algorithm. RESULTS: The FD prevalences were 23.8% and 11.8% according to the Rome I and -II criteria, respectively. Nearly 60% of Rome I-defined FD subjects and 18.9% of Rome II-defined FD subjects had overlapping irritable bowel syndrome (IBS). Irrespective of any Rome definition, FD subjects had excessive physician visits, absenteeism, and sleep disturbances compared to dyspepsia-free controls (p < 0.01). Moreover, over half of the Rome II FD subjects were "consulters" showing excessive physician visits, absenteeism, and sleep disturbances than "non-consulters". The dysmotility-like subgroup (74.5%) comprised the majority of FD subjects and showed no differences to their ulcer-like counterparts in terms of major demographic data and social and health impacts. CONCLUSIONS: FD is a common complaint in Taiwan and also bears an obvious social and medical burden to society. Over half of our FD subjects sought medical help, which may be due to the readily accessible medical care in Taiwan. The newly defined Rome II criteria diminish the chance of co-existence of FD and IBS. Further FD classification by the main symptoms appears of limited clinical usefulness.
OBJECTIVE: The Rome II criteria are a classification of functional gastrointestinal disorders. It is not known whether they can be used as a diagnostic tool. This study evaluates the agreement between GPs and the Rome II criteria on the diagnosis of upper gastrointestinal disorders. MATERIAL AND METHODS: Consecutive patients with abdominal complaints were included in this pragmatic cross-sectional study. All patients answered a questionnaire based on the Rome II criteria. The diagnoses based on these criteria were compared with the GPs' diagnoses. RESULTS: A total of 549 consecutively selected patients were included in the study. The agreement between GPs and the Rome II criteria was 65%, kappa 0.34 (CI 0.27-0.41). The agreement was lower when dyspepsia and gastroesophageal reflux/functional heartburn were evaluated separately. The positive and negative predictive values of the Rome II criteria varied between 29-58% and 82-90%, respectively, in various groups of patients with confirmed diagnoses. CONCLUSIONS: The GPs' diagnoses differed from those based entirely on the Rome II criteria. Strict adherence to the criteria will result in other diseases being disregarded. The diagnoses of upper gastrointestinal disorders should be based on all available information and the Rome II criteria used only as an additional aid to improve the precise classification of functional disorders.
OBJECTIVES: To compare the Rome II diagnoses made in children with recurrent abdominal pain by physicians and by parent and child responses on the Questionnaire on Pediatric Gastrointestinal Symptoms. Rates of diagnostic agreement and reasons for disagreement were examined to determine whether changes to the Rome II criteria are needed to improve diagnostic classification. METHODS: One hundred and forty-eight children and their parents or guardians completed the Questionnaire on Pediatric Gastrointestinal Symptoms during their first visit to a pediatric gastroenterology clinic. Parent- and child-report Rome II diagnoses were based on Questionnaire on Pediatric Gastrointestinal Symptoms scoring criteria, whereas the physician's Rome II diagnosis was based on clinical impression from history and physical examination completed at this visit. Statistical comparisons involved Pearson chi tests and Fisher exact tests. Kappa and weighted kappa measured agreement rates. RESULTS: Most children met the criteria for a functional gastrointestinal disorder based on the Rome II criteria. Functional dyspepsia was the most common diagnosis made by all three sources. The percentage of children classified as "no diagnosis" was small and was often a function of symptom duration (especially when diagnosis rested on the child self-report). Diagnostic agreement was fair to moderate. Diagnoses based on parent and child questionnaires agreed more often on functional dyspepsia than irritable bowel syndrome. Diagnostic disagreement was most likely to result from parent and child disagreement on defecation symptoms. CONCLUSIONS: The Rome II classification system shows promise for improving diagnosis, study and treatment of children with recurrent abdominal pain. However, further refinement and clarification of the Rome II criteria for symptom duration and frequency may be needed to improve diagnostic agreement.
Rome I criteria are highly specific for irritable bowel syndrome (IBS) when red flag signs and symptoms are absent. Physician knowledge of Rome criteria may reduce diagnostic testing. We assessed: (i) physician knowledge of Rome criteria among internists, gastroenterologists and surgeons; (ii) laboratory and endoscopical testing suggested by physicians for sample IBS patients. Physicians of all training levels in internal medicine, gastroenterology, and surgery completed an anonymous questionnaire at a University Medical Center. Subjects were asked to identify Rome criteria among distracters. Sample IBS patients were presented, and physicians were asked to suggest a diagnostic workup based on the choices provided on the questionnaire. Rome knowledge was highest among gastroenterologists and lowest among surgeons. Physicians suggested endoscopical procedures in 67% of IBS patients with diarrhoea and in 46% with constipation. There was no difference among specialties in amount of laboratory or endoscopical testing suggested. Knowledge and use of the Rome criteria or their positive predictive value (PPV) for IBS did not correlate with reduced diagnostic testing. Education regarding the Rome criteria should be extended to surgical specialists who are likely to evaluate and operate on IBS patients. Endoscopical evaluation of IBS patients may be excessive.
The new Rome III criteria reflects upon a more than 15 year process to legitimize, classify and bring scientific credibility to the functional GI disorders. This has occurred through a series of activities and documents including the recently published Rome III book and a journal issue in Gastroenterology published in April, 2006. The work involved has involved committees of 87 international investigators from 17 countries, 2 of whom are from China. This article will review the Rome committee process that led to the production of these documents, the Rome III classification system, a description of the changes from Rome II (published in 2000) to Rome III and information on the future of Rome Foundation activities.
BACKGROUND: Irritable bowel syndrome (IBS) is a common functional gastro-intestinal disease. In the absence of specific markers, definition and hence diagnosis depend on clinical presentation. Of the various attempts to set criteria for IBS, the most recent are Rome I and Rome II classifications. AIMS: To estimate in a general population the prevalence of IBS using the modified Rome I criteria, and to investigate socio-demographic criteria, symptoms and management. METHODS: A total of 11,131 people aged 18 years and over, representative of the French population, were surveyed. A diagnostic questionnaire based on the modified Rome I criteria was used to identify IBS sufferers, who were then questioned further about the symptoms and medical management of their IBS. RESULTS: Of the 5,299 men and 5,832 women interviewed, 445 had IBS according to the Rome I criteria, a prevalence of 4% (95% CI: 3.6%-4.4%). IBS was more frequent in women (5.3%) than in men (2.5%), with a sex ratio (F/M) of 2.3. In 9.1% of sufferers, onset had occurred less than 12 months ago, a yearly incidence of 3.6 per 1,000 of the population. In 32.3% of IBS sufferers diarrhoea was predominant, and in 34.6% constipation was predominant. Of IBS sufferers 83.7% had consulted a physician for their condition, and 87.6% had taken medication for their IBS symptoms over the previous 12 months. CONCLUSION: The prevalence of IBS observed in this study in France was close to the lower limit in published data (3 to 20%). Our results suggest that the Rome I criteria are not sensitive enough to detect all IBS patients in a population not actively seeking health care intervention for the condition. In this regard, the refined classification (Rome II) which was established after our study was carried-out should be evaluated.
Platinum concentrations in topsoil samples collected in 1992 (48) and in 2001 (16) from the urban area of Rome have been determined by ICP-MS. Concentrations in 47 soil samples collected in 1992 from natural sites of Latium (an area around Rome) have been determined for a first assessment of natural background levels. The Pt concentrations in Rome urban soils collected in 1992 range from 0.8 to 6.3 ng/g (mean = 3.8 +/- 1.0) overlapping the concentration range of natural soils from Latium (mean = 3.1 +/- 2.1 ng/g). No significant correlation has generally been found between Pt contents in the 'natural' soils and related bedrock or major pedogenetic parameters. These results suggest that there is no evidence of Pt pollution in Rome urban soils at that time, because the massive use of the automobile catalytic converter has only just started. Higher (up to six times more) Pt concentrations, than those measured in the 1992 samples, have been measured, in some cases, in Rome urban soils collected in 2001, suggesting a possible start of Pt accumulation because of the large-scale use in the last decade of automobile catalytic converters. At the same time, a clear decrease of lead levels in Rome urban soils with respect to the levels measured in 1992 has been observed, paralleling the decreasing number of lead gasoline-fuelled cars. Here we present one of the first systematic studies for defining background levels of Pt in Italian natural soils, thus allowing for monitoring, in the future, should any possible Pt pollution caused by the use of automobile catalytic converter, especially in urban soils, occur.
BACKGROUND: It has been unclear as to whether the Rome II criteria could be applied to patients in the Asia region with functional gastrointestinal (GI) diseases. The aim of the present study was to determine if symptoms of Asian patients with functional gastrointestinal disorders formed groups which corresponded to the Rome II diagnostic criteria. METHODS: A modified English version of Talley's bowel disease questionnaire was developed in collaboration with various research teams in accordance with the Rome II criteria. This instrument was translated into the local languages of the following nine Asian regions: China, Hong Kong, Indonesia, Korea, Malaysia, Singapore, Taiwan, Thailand and Vietnam. From September to December 2001, newly enrolled outpatients attending 14 GI or medical clinics in these regions were invited to complete the questionnaire. From these respondents, patients with functional gastrointestinal disorders fulfilling the '12 weeks out of 12 months' criteria were separated for further analysis. Principal component factor analysis with varimax rotation was used to identify symptom clusters or factors. These factors were compared with the existing classification of functional GI diseases derived from the Rome II criteria. RESULTS: Factor analysis of symptoms from 1012 functional GI patients supported the Rome II classification of the following groups of functional GI disorders: diarrhea-predominant irritable bowel syndrome, functional constipation, functional dyspepsia, functional abdominal pain syndrome, functional heartburn, and functional vomiting. Functional diarrhea was combined with functional anorectal disorders, and globus merged with functional dysphagia into one factor. Some of the functional dyspepsia, abdominal bloating and belching symptoms were loaded into one factor. CONCLUSIONS: Factor analysis of symptoms from a sample of Asian patients with functional GI disorders partially supported the use of the Rome II classification.
BACKGROUND: The new guidelines for diagnosing irritable bowel syndrome (IBS) in clinical practice recommend the use of the Rome II criteria. In this study the agreement between general practitioners (GPs) and the Rome II criteria for diagnosing of IBS and functional bowel disorders (FBD) is examined. METHODS: Consecutive patients in general practice were asked to report on abdominal complaints, for which they had consulted or wanted to consult a GP. Patients with such complaints completed a questionnaire based on the Rome II criteria for FBD. After consultations, the GPs reported their diagnoses on the abdominal complaints. RESULTS: Of 3097 screened patients, 553 patients were diagnosed by their GP and had complete data in the questionnaire. Of these patients, 107 had IBS according to the GPs and 209 had IBS according to the Rome II criteria (agreement 58%, kappa 0.01 (CI: -0.06; 0.09)). Agreement on IBS and FBD in patients without organic disease, without reflux or dyspepsia and in patients with a verified diagnosis was 45%-58%, with kappa values from -0.02 to 0.13. IBS and FBD cases were diagnosed by the Rome II criteria more often than by the GPs in all these groups of patients (P < 0.001). In patients with diagnostic discrepancies concerning IBS, 'stress-related symptoms' was predictive of a diagnosis of IBS made by the GPs only (OR 2.17 (CI: 1.1; 4.2)). CONCLUSIONS: This study shows poor agreement in the diagnosis of IBS between GPs and the Rome II criteria. Therefore, current knowledge about IBS based on strict criteria is not necessarily transferable to patients with IBS in general practice.
OBJECTIVES: Recurrent abdominal pain (RAP) is a common childhood complaint rarely associated with organic disease. Recently, the Pediatric Rome Criteria were developed to standardize the classification of pediatric functional gastrointestinal disorders (FGIDs) using a symptom-based approach. The authors tested the hypothesis that most patients with childhood RAP could be classified into one or more of the symptom subtypes defined by the Pediatric Rome Criteria. METHODS: Using a prospective longitudinal design, new patients with RAP (n = 114) were studied at a tertiary care children's medical center. Before the medical evaluation, parents completed a questionnaire about their child, assessing symptoms defined by the Pediatric Rome Criteria. RESULTS: Of the 107 children for whom medical evaluation revealed no organic etiology for pain, 73% had symptom profiles consistent with the Pediatric Rome Criteria for one of the FGIDs associated with abdominal pain (irritable bowel syndrome, 44.9%; functional dyspepsia,15.9%; functional abdominal pain, 7.5%; abdominal migraine, 4.7%) CONCLUSIONS: This study provides the first systematic empirical evidence that RAP, originally defined by Apley, includes children whose symptoms are consistent with the symptom criteria for several FGIDs defined by the Rome criteria. The pediatric Rome criteria may be useful in clinical research to (1) describe the symptom characteristics of research participants who meet Apley's broad criteria for RAP, and (2) select patients with particular symptom profiles for investigation of potential biologic and psychosocial mechanisms associated with pediatric FGIDs.
OBJECTIVE: Our aim was to examine the predictive value of the Rome criteria and absence of so-called "red flags" of clinical practice for diagnosing irritable bowel syndrome. Red flags were relevant abnormalities on physical examination, documented weight loss, nocturnal symptoms, blood in stools, history of antibiotic use, and family history of colon cancer. METHODS: In retrospective studies, 98 patients who had one or more Rome criteria and lacked red flags were identified by chart review of a 1-yr period. In prospective studies, 95 patients were identified who met the Rome criteria and lacked red flags. Sensitivity, specificity, predictive value of Rome criteria, and absence of red flags were determined. Consultant's final diagnosis was the gold standard. Investigations before and after referral were recorded and reason for referral was determined in prospective studies. RESULTS: In the retrospective series, the Rome criteria and absence of red flags had a sensitivity of 65%, specificity of 100%, and positive predictive value of 100%. None of these patients required revision of their diagnosis during a 2-yr follow-up. In the prospective study, the positive predictive value was 98%. More than 50% of the patients in this group had been referred because of diagnostic uncertainty and 24% had had an abdominal ultrasound; 66% of those <45 yr old underwent at least partial colonic evaluation. CONCLUSIONS: These findings suggest that the Rome criteria combined with a lack of red flags have a very high predictive value for diagnosing irritable bowel syndrome. Application of these diagnostic criteria has the potential to alter utilization of health care resources.
The publication in the April, 2006 issue of Gastroenterology of Rome III has made available to the scientific world an enhanced and updated version of the Rome criteria and related information on the functional GI disorders. It is expected that the criteria will be adopted and used by physicians, pharmaceuticals and regulatory agencies worldwide, just as the previous Rome II became the standard for clinical practice and research. In this issue of J Gastrointestin Liver Dis, these Guidelines, the Rome III, are presented. Also included are some of the differences between Rome II and Rome III criteria as well as the rationale for publishing this new version.