ObjectivesDespite being proposed 4 years ago, there has been no independent validation study of the Rome IV criteria for IBS. We assessed their performance for the diagnosis of IBS in secondary care and compared them with the previous iteration, the Rome III criteria.DesignWe collected complete symptom data from consecutive adult patients with suspected IBS referred to a single UK clinic. All subjects underwent relatively standardised workup, with assessors blinded to symptom status. The reference standard used to confirm IBS was the presence of lower abdominal pain or discomfort in association with altered stool form or frequency, in a patient with no evidence of organic gastrointestinal disease after investigation. Sensitivity, specificity and positive and negative likelihood ratios (LRs), with 95% CIs, were calculated for each of the diagnostic criteria.ResultsThe level of agreement between the Rome IV and Rome III criteria was good (kappa=0.65). Compared with the reference standard, sensitivity and specificity of the Rome IV criteria in 572 patients (431 (75.3%) women, mean age 36.5 years) were 82.4% and 82.9%, respectively. Positive and negative LRs for the Rome IV criteria were 4.82 (95% CI 3.30 to 7.28) and 0.21 (95% CI 0.17 to 0.26), respectively. The Rome IV criteria performed best in those with IBS with constipation or mixed bowel habits. In 471 patients (350 (74.3%) women, mean age 36.7 years), compared with the reference standard, the sensitivity and specificity of the Rome III criteria were 85.8% and 65.0%; positive and negative LRs were 2.45 (95% CI 1.90 to 3.27) and 0.22 (0.16 to 0.29), respectively. Incorporating mood and extraintestinal symptom reporting into diagnostic criteria did not improve their performance significantly.ConclusionsThe Rome IV criteria performed significantly better than the Rome III criteria in diagnosing IBS in this single centre secondary care study, although the clinical relevance of this is uncertain.

• Radiation dose is a concern when imaging patients with Crohn's disease. • New techniques allow low-dose abdominopelvic CT with acceptable image quality. • Using hybrid iterative reconstruction, its diagnostic yield compares well with that of conventional CT. • Sub-millisievert CT of patients with Crohn's disease appears technically and clinically feasible.

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Although epidemiological findings support a role for vitamin K status in the improvement of bone indices in adult patients with Crohn's disease (CD), this needs to be confirmed in double-blind, randomised controlled trials (RCT) with phylloquinone (vitamin K 1 ). By conducting two RCT, the present study aimed to first establish whether supplementation with 1000 mg of phylloquinone daily near-maximally suppresses the percentage of undercarboxylated osteocalcin in serum (%ucOC; marker of vitamin K status) in adult patients with CD currently in remission as it does in healthy adults and second determine the effect of supplementation with phylloquinone at this dose for 12 months on the indices of bone turnover and bone mass. The initial dose-ranging RCT was conducted in adult patients with CD (n 10 per group) using 0 (placebo), 1000 or 2000 mg of phylloquinone daily for 2 weeks. In the main RCT, the effect of placebo v. 1000mg vitamin K/d (both coadministered with Ca (500 mg/d) and vitamin D 3 (10 mg/d)) for 12 months (n 43 per group) on the biochemical indices of bone turnover (determined by enzyme immunoassay) and bone mass (determined by dual-energy X-ray absorptiometry) were investigated. At baseline, the mean %ucOC was 47 %, and this was suppressed upon supplementation with 1000 mg of phylloquinone daily (281 %; P,0·01) and not suppressed further by 2000 mg of phylloquinone daily. Compared with the placebo, supplementation with 1000 mg of phylloquinone daily for 12 months had no significant effect (P.0·1) on bone turnover markers or on the bone mass of the lumbar spine or femur, but modestly increased (P,0·05) the bone mass of the total radius. Despite near maximal suppression of serum %ucOC, supplementation with 1000 mg of phylloquinone daily (with Ca and vitamin D 3 ) had no effect on the indices of bone health in adult CD patients with likely vitamin K insufficiency.Key words: Phylloquinone (vitamin K 1 ): Percentage of undercarboxylated osteocalcin: Bone health indices: Intervention studies: Crohn's disease Osteopaenia and osteoporosis are common conditions among patients with Crohn's disease (CD) (1,2) . Bone loss resulting from these conditions is a major risk factor for osteoporotic fractures of the spine, wrist and hip (3) , which can have a deleterious effect on the quality of life of patients with CD, especially in young patients who have a normal life expectancy. Although the pathogenesis of osteopaenia and osteoporosis in CD is likely to be multifactorial, the existence of nutritional inadequacies of Ca and vitamin D in these patients has been implicated (4 -9) .The prevalence of vitamin K deficiency in patients with chronic gastrointestinal disorders has been known for some time (10) . The concentration of undercarboxylated osteocalcin (ucOC) and the percentage of osteocalcin present in an undercarboxylated state (%ucOC) are markers of diminished vitamin K nutritive status (11) . Adult patients with CD, even those in remission and not taking high-dose steroids, have been shown to have hi...

The functional gastrointestinal disorders (FGID) are symptom-based disorders that cannot be currently explained by definable structural or biochemical causes (1). These disorders are common: the presence of at least one functional GI disorder was identified in 70% of participants in a large US householder survey (2). An associated co-morbid psychiatric condition such as anxiety, mood or panic disorder is seen in up to 60% of those attending gastroenterology outpatient clinics with a functional compliant (3). Functional GI disorders are associated with significant impairment of quality of