Functional bowel disorders and functional abdominal pain

Abstract

The Rome diagnostic criteria for the functional bowel disorders and functional abdominal pain are used widely in research and practice. A committee consensus approach, including criticism from multinational expert reviewers, was used to revise the diagnostic criteria and update diagnosis and treatment recommendations, based on research results. The terminology was clarified and the diagnostic criteria and management recommendations were revised. A functional bowel disorder (FBD) is diagnosed by characteristic symptoms for at least 12 weeks during the preceding 12 months in the absence of a structural or biochemical explanation. The irritable bowel syndrome, functional abdominal bloating, functional constipation, and functional diarrhea are distinguished by symptom-based diagnostic criteria. Unspecified FBD lacks criteria for the other FBDs. Diagnostic testing is individualized, depending on patient age, primary symptom characteristics, and other clinical and laboratory features. Functional abdominal pain (FAP) is defined as either the FAP syndrome, which requires at least six months of pain with poor relation to gut function and loss of daily activities, or unspecified FAP, which lacks criteria for the FAP syndrome. An organic cause for the pain must be excluded, but aspects of the patient’s pain behavior are of primary importance. Treatment of the FBDs relies upon confident diagnosis, explanation, and reassurance. Diet alteration, drug treatment, and psychotherapy may be beneficial, depending on the symptoms and psychological features.

Validation of the Rome III Criteria for the Diagnosis of Irritable Bowel Syndrome in Secondary Care

“…As the questionnaire contained other symptom items, we were also able to classify the presence or absence of IBS according to the following previously accepted gold-standard symptom-based criteria, which preceded the Rome III criteria: the Manning criteria (using the presence of ≥3 of these to define IBS in our primary analysis, as this is the most widely accepted threshold, but also using ≥2 or ≥4 criteria in a sensitivity analysis), 19 the Rome I criteria, 21 and the Rome II criteria (see Supplementary Table 1). 22 We conducted further sensitivity analyses where individuals reporting lower GI alarm symptoms, including a positive family history of colorectal cancer, rectal bleeding, weight loss, or anemia were excluded from the diagnosis of IBS using any of these criteria.…”

“…20 These observations led to the development of the Rome I criteria, 21 which have been revised on two subsequent occasions to produce the Rome II and Rome III criteria. 1,22 Guidelines for the management of IBS from national organizations encourage physicians to make a positive diagnosis of IBS, using these symptom-based diagnostic criteria, and to avoid extensive investigation. [23][24][25] Accurate diagnostic criteria for IBS are of paramount importance, as they allow physicians to make the diagnosis with confidence, hence reducing the costs of managing the condition to the health service, and reassure patients that their physician's opinion is correct.…”

Enteric ganglioneuritis and abnormal interstitial cells of Cajal

“…Still, these criteria were used to classify patients with IBS-and dyspepsia-like symptoms (13), as these criteria are the only available for description of these symptoms. IBS was found in 9 of 19 patients with CD, and in 3 of 11 patients with UC.…”

IgG and IgG4 antibodies in subjects with irritable bowel syndrome: a case control study in the general population

“…The food and drink questions in our study were the same as the food and drink questions in The Oslo Health Study, which has been translated from Norwegian to English [14]. The following information was gathered from the questionnaires: demographics, smoking habits, activity habits, diet, common diseases (asthma, bronchitis, diabetes, osteoporosis, fibromyalgia, mood disorders, heart attack, angina, cerebral stroke) (number of diseases, score 0–9), allergic rhinitis, mood disorders as measured by the Hopkins Symptom Checklist 10 (HSCL10) (score 1.0-4.0, mental distress ≥ 1.85), musculoskeletal complaints (score 0–12), and gastrointestinal symptoms of which IBS was defined according to a translation of the Rome II criteria [15]. IBS subgroups were classified as constipation-predominant IBS (C-IBS), alternating IBS (A-IBS), or diarrhoea-predominant IBS (D-IBS).…”