Splitting Irritable Bowel Syndrome: From Original Rome to Rome II Criteria

Fermin Mearin, M.D.; Montse Roset Ph.D.; Xavier Badía, M.D.; Agustin Balboa, M.D.; Eva Baró, Ph.D.; Julio Ponce, M.D.; Manuel Díaz-Rubio, M.D.; Ellen Caldwell, Ph.D.; Mercedes Cucala, M.D.; Arturo Fueyo, M.D.; Nicholas J. Talley, M.D.

Disclosures

Am J Gastroenterol. 2004;99(1) 

In This Article

Abstract and Introduction

Objectives: Diagnosis of irritable bowel syndrome (IBS) and other functional bowel disorders (FBD) is based on symptom evaluation. Clinical criteria have changed over time, yielding different proportions of subjects fulfilling diagnostic requirements. According to new diagnostic criteria (Rome II), subjects considered some years ago to have IBS no longer do so. The aim of this article is to evaluate how patients diagnosed as having IBS according to original Rome criteria have been split, and to which clinical diagnosis they belong today.
Methods: Two hundred and eleven subjects meeting original Rome IBS diagnostic criteria were studied: 65 also met Rome II criteria while 146 did not. Subjects were extracted from an epidemiological survey, using home-based personal interviews, on 2,000 subjects randomly selected as representative of the Spanish population. Clinical complaints, personal well-being, resource utilization, and health-related quality of life (HRQOL) were compared.
Results: Of the subjects meeting original Rome but not Rome II criteria, the present diagnosis should be: 40%"minor" IBS (IBS symptoms of less than 12 wk duration), 37% functional constipation, 12% alternating bowel habit, 7% functional diarrhea, 3% functional abdominal bloating, and 1% unspecified functional bowel disorder (FBD). Thus, 52 subjects (36%) should not be diagnosed with IBS because they really had other FBD, 59 (40%) because of symptoms consistent with IBD diagnosis but not the required duration or frequency, and 35 (24%) because of symptoms consistent with some other FBD diagnosis but not meeting the required duration. Clinical complaints, personal well-being, resource utilization, and HRQOL were more severely affected in IBS than in other FBD as a group, and in "major" rather than in "minor" forms.
Conclusions: Many subjects meeting original Rome criteria for IBS do not meet Rome II criteria: approximately one quarter of subjects do not have sufficient symptom duration or frequency to be diagnosed with IBS and almost half are now considered as having other ("major" or "minor") FBD.

Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder which, together with functional dyspepsia, is one of the most common causes of patient consultation for digestive complaints.[1] IBS comprises a group of functional bowel disorders in which abdominal discomfort or pain is associated with defecation or a change in bowel habits, and that features disordered defecation.[2] IBS diagnosis is based mainly on symptom evaluation and clinical criteria, in addition to the ruling out of organic disturbances.[3,4] Several diagnostic criteria have been developed based on the presence and/or frequency of symptoms. The first attempt, made by Manning in 1978,[5] was based on a comparison of gastrointestinal symptoms between a group of patients diagnosed as having IBS and a group of patients with various organic diseases. These criteria were subsequently modified by various investigators, and other new criteria, including those of the Rome I and Rome II consensus, have been developed.[1,6,7,8,9,10,11] Previous experience has demonstrated that the estimated prevalence of IBS varies enormously depending on the diagnostic criteria employed. The prevalence values for IBS using the Manning criteria have ranged from 12.8% in the United States (≥3 criteria)[6] to 21.6% in the UK (≥2 criteria),[7] while with the Rome I criteria values have varied between 9.4% in the United States[12] and 15% in Sweden[13]; much lower IBS prevalence rates are obtained when the currently recommended Rome II criteria are applied: around 3-5%.[14,15] In fact, we have shown that more than two thirds of subjects meeting the original Rome criteria would not be diagnosed as having IBS if Rome II criteria were employed.[15] This is due to two main reasons: first, Rome II criteria require the presence of both abdominal discomfort/pain and changes in bowel habits,[11] while in the original Rome criteria abdominal pain and disturbed defecation could be considered independently to establish the diagnosis[10]; second, in Rome II criteria a minimum duration of symptoms is required (at least 12 wk in the preceding 12 months),[11] while in the original Rome criteria no minimum duration was required.[10] Thus, a significant number of patients meeting the original Rome criteria do not the meet Rome II criteria since they have other functional bowel disorders (FBD) but not IBS (according to Rome II) or because insufficient symptom duration was present for the diagnosis of functional gastrointestinal disorder to be made.

From a practical point of view, this discrepancy is important not only to estimate different disorder prevalences but also to determine whether a given person suffers (or not) from IBS or other FBD, and therefore how to direct diagnosis and treatment.

The aim of the present study was to evaluate how patients diagnosed as having IBS according to the original Rome criteria have been split, and to which clinical diagnosis they belong today according to Rome II criteria. Clinical complaints, personal well-being, resource utilization, and HRQOL were analyzed and compared among subjects meeting different IBS criteria (original Rome vs Rome II) or other FBD.

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