Spectra of functional gastrointestinal disorders diagnosed by Rome III integrative questionnaire in a Japanese outpatient office and the impact of overlapping

Background/Aims The development-processes by regional socio-cultural adaptation of an Enhanced Asian Rome III questionnaire (EAR3Q), a cultural adaptation of the Rome III diagnostic questionnaire (R3DQ), and its translation-validation in Asian languages are presented. As English is not the first language for most Asians, translation-validation of EAR3Q is essential. Hence, we aimed to culturally adapt the R3DQ to develop EAR3Q and linguistically validate it to show that the EAR3Q is able to allocate diagnosis according to Rome III criteria. Methods After EAR3Q was developed by Asian experts by consensus, it was translated into Chinese, Hindi-Telugu, Indonesian, Korean, and Thai, following Rome Foundation guidelines; these were then validated on native subjects (healthy [n = 60], and patients with irritable bowel syndrome [n = 59], functional dyspepsia [n = 53] and functional constipation [n = 61]) diagnosed by clinicians using Rome III criteria, negative alarm features and investigations. Results Experts noted words for constipation, bloating, fullness and heartburn, posed difficulty. The English back-translated questionnaires demonstrated concordance with the original EAR3Q. Sensitivity and specificity of the questionnaires were high enough to diagnose respective functional gastrointestinal disorders (gold standard: clinical diagnoses) in most except Korean and Indonesian languages. Questionnaires often uncovered overlapping functional gastrointestinal disorders. Test-retest agreement (kappa) values of the translated questionnaires were high (0.700–1.000) except in Korean (0.300–0.500) and Indonesian (0.100–0.400) languages at the initial and 2-week follow-up visit. Conclusions Though Chinese, Hindi and Telugu translations were performed well, Korean and Indonesian versions were not. Questionnaires often uncovered overlapping FGIDs, which were quite common.

Section: Discussionmentioning

confidence: 99%

Development, Translation and Validation of Enhanced Asian Rome III Questionnaires for Diagnosis of Functional Bowel Diseases in Major Asian Languages: A Rome Foundation-Asian Neurogastroenterology and Motility Association Working Team Report

Ghoshal¹,

Gwee²,

Chen³

et al. 2015

“…They proposed that the wide range in overlap rates of FD and IBS were due to different diagnostic criteria used for each condition. In addition to these 2 systematic reviews, there are several reports regarding the overlap of dyspepsia/FD and IBS; [48][49][50] therefore, it is clear that dyspepsia/FD and IBS frequently overlap. As a result, we will discuss the clinical characteristics of this overlap.…”

Section: Dyspepsia With Lower Gastrointestinal Diseasesmentioning

confidence: 99%

Overlap in Patients With Dyspepsia/Functional Dyspepsia

Fujiwara¹

2014

Patients with dyspepsia/functional dyspepsia (FD) show frequent overlapping of other gastrointestinal (GI) diseases, such as irritable bowel syndrome, and non-GI diseases, in addition to internal subgroup overlapping. These overlap patients have more frequent or more severe symptoms, poorer health-related quality of life and higher somatization scores, and they are more likely to experience anxiety, depression or insomnia compared to non-overlap patients. The higher prevalence of overlap in patients with dyspepsia/FD is not by chance, indicating common pathogeneses, including visceral hypersensitivity, altered GI motility, infection, and stressful early life events. There are few clinical trials targeting overlap in patients with dyspepsia/FD, and no therapeutic strategy has been established. Further studies in this research area are needed. In this review, we describe the epidemiology, pathogenesis and treatment of overlap in patients with dyspepsia/FD.

“…This is consistent with a report of hospital outpatients in Japan. 39 The investigation environment, the definition of symptom duration, and the accuracy of excluding organic diseases have all been identified as factors affecting the prevalence of FGIDs. In the Rome II definition, 2 the symptom duration of FD and IBS was defined as at least 12 weeks during the preceding 12 months, and in Rome III, 1 at least 3 months with symptom onset at least 6 months prior to diagnosis, which implies that the duration of symptoms can easily change the prevalence.…”

Section: Prevalencementioning

confidence: 99%

“…43 On the other hand, when patients who visited a general hospital in Japan were analyzed, the prevalences of FD and IBS defined by Rome III criteria were 2.1% and 2.4%, respectively. 39 Therefore, when we evaluate the prevalence of FGIDs, we should take the background characteristics of the analyzed subjects into account.…”

Section: Prevalencementioning

confidence: 99%

Epidemiology of Functional Gastrointestinal Disorders in Japan and in the World

Oshima

Miwa

2015

138

130

Functional gastrointestinal disorders (FGIDs), represented by functional dyspepsia (FD) and irritable bowel syndrome (IBS), are a group of disorders that include variable combinations of chronic or recurrent gastrointestinal symptoms not explained by structural or biochemical abnormalities. FGIDs account for a significant percentage of patients seen in primary care settings with abdominal symptoms. Although the definition of FGIDs can easily affect the prevalence, the prevalences of dyspepsia/FD and IBS diagnosed by the Rome III criteria in the general population are 5.3-20.4% and 1.1-29.2%, respectively. Recent reports of FD and IBS defined by the Rome III criteria indicated a female predominance. Regarding the subtype prevalence of FD, postprandial distress syndrome was more prevalent than epigastric pain syndrome (5.6-13.9% vs 0.9-9.5%). The subtype prevalence of IBS is characterized by male predominance for IBS with diarrhea and female predominance for IBS with constipation. Factors affecting the development of FGIDs such as epidemiological factors including genetic and environmental factors, are important. Gene polymorphisms are involved in the development of FGIDs. The prevalence differs among races and geographic areas. Foods may affect the development of FGIDs, but the causal relationships between food and FGIDs are not conclusive. The symptoms often regress and appear in the course of these entities. Building a favorable patient-doctor relationship is effective for controlling symptoms of FGIDs. Physicians should explain that FGIDs are highly prevalent conditions, impair the patients' quality of life even without evident underlying organic causes and are not life-threatening conditions to ensure patients' understanding.