Leeds Gastroenterology Institute, St James's University Hospital, Leeds, United Kingdom; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, United Kingdom.
County Durham and Darlington NHS Foundation Trust, Durham, United Kingdom.
Clin Gastroenterol Hepatol. 2020 Feb;18(2):392-398.e2. doi: 10.1016/j.cgh.2019.05.037. Epub 2019 May 31.
Few studies have examined the effects of applying the Rome IV criteria for irritable bowel syndrome (IBS) vs the previous standard, the Rome III criteria. We conducted a cross-sectional survey of individuals who self-identify as having IBS to examine this issue.
We collected complete demographic, symptom, mood, and psychological health data from 1375 adults who self-identified as having IBS, but were not recruited from a referral population. We applied the Rome III and the Rome IV criteria simultaneously to examine what proportion met each of these diagnostic criteria for IBS. We measured the level of agreement between the Rome III and Rome IV criteria, and assessed for presence of an alternative functional bowel disorder in individuals who no longer met diagnostic criteria for IBS with the more restrictive Rome IV criteria. Finally, we compared characteristics of individuals who met only Rome III criteria with those who met Rome IV criteria.
In total, 1080 of 1368 individuals (78.9%) with IBS met the Rome III criteria. In contrast, 811 of 1373 individuals (59.1%) with IBS met the Rome IV criteria. Agreement between the criteria was only moderate (Kappa = 0.50). Among those who no longer had IBS according to the Rome IV criteria, 33 (11.5%) met Rome IV criteria for functional constipation, 118 (41.3%) for functional diarrhea, 68 (23.8%) for functional abdominal bloating or distension, and 67 (23.4%) for an unspecified functional bowel disorder. Individuals with Rome IV-defined IBS had more severe symptoms, and a higher proportion had a mood disorder and evidence of poor psychological health, compared with individuals who only met the Rome III criteria for IBS (P < .001).
The characteristics of people who believe they have IBS differ between those who meet criteria as defined by Rome IV vs Rome III, including the spectrum of disease severity. Studies are needed to determine how these changes will affect outcomes of clinical trials.
很少有研究探讨应用罗马 IV 标准诊断肠易激综合征（IBS）与之前的标准罗马 III 标准相比的效果。我们对自认为患有 IBS 的个体进行了横断面调查，以研究这个问题。
我们从 1375 名自认为患有 IBS 的成年人中收集了完整的人口统计学、症状、情绪和心理健康数据，但他们不是从转诊人群中招募的。我们同时应用罗马 III 和罗马 IV 标准来检查符合这些 IBS 诊断标准的比例。我们测量了罗马 III 和罗马 IV 标准之间的一致性，并评估了在更严格的罗马 IV 标准下不再符合 IBS 诊断标准的个体中是否存在另一种功能性肠病。最后，我们比较了仅符合罗马 III 标准的个体和符合罗马 IV 标准的个体的特征。
在总共 1368 名 IBS 患者中，有 1080 名（78.9%）符合罗马 III 标准。相比之下，在 1373 名 IBS 患者中，有 811 名（59.1%）符合罗马 IV 标准。标准之间的一致性仅为中等（Kappa=0.50）。在根据罗马 IV 标准不再患有 IBS 的患者中，33 名（11.5%）符合罗马 IV 功能性便秘标准，118 名（41.3%）符合罗马 IV 功能性腹泻标准，68 名（23.8%）符合罗马 IV 功能性腹胀或不适标准，67 名（23.4%）符合罗马 IV 未特指的功能性肠病标准。与仅符合罗马 III 标准的 IBS 患者相比，符合罗马 IV 定义的 IBS 患者的症状更严重，且心境障碍和心理健康不良的比例更高（P<0.001）。
与符合罗马 III 标准的患者相比，认为自己患有 IBS 的患者的特征在符合罗马 IV 标准的患者中有所不同，包括疾病严重程度的范围。需要研究这些变化将如何影响临床试验的结果。
