Comparisons of the Rome III and Rome IV criteria for diagnosis of irritable bowel syndrome in Indian and Bangladeshi communities and internal shifts in the diagnostic categories of bowel disorders of gut–brain interactions

Abstract

Background Although the Rome IV criteria are the most recent criteria to diagnose irritable bowel syndrome (IBS), their sensitivity has been shown to be low in Chinese and Western populations. There are scanty data comparing the Rome III and Rome IV criteria in diagnosis of IBS in the Indian and Bangladeshi populations where abdominal pain, an essential component of diagnosis of IBS by the Rome IV criteria, is less in frequency and of lower severity. Methods We analyzed the Indian and Bangladeshi data from the Rome Global Epidemiology Study to compare diagnostic sensitivity of the Rome III and Rome IV criteria for IBS, internal shifts in diagnostic categories of disorders of gut–brain interaction (DGBI), the severity of IBS diagnosed by the Rome III and Rome IV criteria, and consultation patterns in these populations. Key Results The Rome IV criteria were less sensitive than the Rome III criteria to diagnose IBS in these populations, and the subjects with Rome III IBS shifted internally to other DGBI when the Rome IV criteria were applied. Moreover, Rome IV IBS subjects had greater symptom severity than the Rome III IBS. A third of people fulfilling diagnostic criteria for IBS consulted doctors, and those diagnosed using Rome IV criteria, those with higher anxiety and depression symptom score, lower global physical health score, and greater IBS symptom severity score had greater correlation coefficients with doctors' consultation. Conclusions and Inferences The Rome IV diagnostic criteria for IBS are less sensitive than the Rome III criteria in Indian and Bangladesh communities. Application of the Rome IV criteria to people who meet the Rome III IBS criteria selects a subgroup of people with greater severity of symptoms, and hence, Rome IV IBS is more strongly associated with physician consultation. These findings may have important bearing in future iterations of the Rome criteria for a broader global applicability.

A prospective comparison of UK and Malaysian patients with irritable bowel syndrome in secondary care

“…The pooled prevalence of IBS from the Rome Foundation global internet survey was 10.1% and 4.1%, based on the Rome III and the Rome IV criteria, respectively 6 . The Rome IV criteria requires abdominal ‘pain’, instead of ‘discomfort’, that is related to defaecation to diagnose IBS, a higher symptom frequency threshold of at least once per week, and has been reported to be associated with a more severe spectrum of IBS 12,29 . Given the UK patients with IBS in the current study had more severe symptoms, it is not surprising that a greater proportion of UK patients fulfilled Rome IV criteria for IBS, and this may explain our findings to some degree.…”

Editorial: Recognising the regional variations in profile of irritable bowel syndrome—better late than never! Authors' reply

“…We agree that the likely driver of more severe symptoms and a greater negative impact of IBS among UK vs. Malaysian patients was the higher level of psychological co‐morbidity as shown in our study. This was similarly demonstrated by a study from India and Bangladesh 6 . Other possibilities for the differences in IBS severity seen between these two geographical regions could be due to dietary habits, including alcohol intake, which has been reported to be a risk factor for small intestinal bacterial overgrowth (SIBO).…”

“…This was similarly demonstrated by a study from India and Bangladesh. 6 Other possibilities for the differences in IBS severity seen between these two geographical regions could be due to dietary habits, including alcohol intake, which has been reported to be a risk factor for small intestinal bacterial overgrowth (SIBO). Of interest, SIBO is recognised to be associated with IBS 7 and even linked to a more severe form of IBS.…”

Editorial: Recognising the regional variations in profile of irritable bowel syndrome—better late than never!

“…Rome IV-defined IBS is more severe than Rome III-defined IBS. 9 Lack of uniform applicability of Rome criteria, particularly Rome IV criteria, to diagnose and subtype IBS is well known in Asia 9,10 ; Rome IV-defined IBS more often has mental health abnormalities. 9 Similar data are presented in this study.…”

“…Although Rome III criteria were used for inclusion, more patients in the UK (71%) than Malaysia (49%) fulfilled Rome IV criteria. Rome IV‐defined IBS is more severe than Rome III‐defined IBS 9 . Lack of uniform applicability of Rome criteria, particularly Rome IV criteria, to diagnose and subtype IBS is well known in Asia 9,10 ; Rome IV‐defined IBS more often has mental health abnormalities 9 .…”