Goodoory Vivek C, Houghton Lesley A, Yiannakou Yan, Black Christopher J, Ford Alexander C
Leeds Institute of Medical Research, Leeds, United Kingdom; Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom.
Leeds Institute of Medical Research, Leeds, United Kingdom.
Clin Gastroenterol Hepatol. 2022 Mar;20(3):569-577.e3. doi: 10.1016/j.cgh.2021.04.043. Epub 2021 May 3.
BACKGROUND & AIMS: Irritable bowel syndrome (IBS) is a chronic functional bowel disorder diagnosed using the Rome criteria, which have evolved since their original description 30 years ago. Little is known about the effects on the natural history of IBS of moving to the latest iteration, Rome IV, from the previous Rome III criteria. We conducted a 12-month longitudinal follow-up study to examine this.
We collected complete demographic, symptom, mood, and psychological health data at baseline from 1097 adults who self-identified as having IBS and met either Rome IV or Rome III criteria. At 12 months, we collected data regarding IBS symptom severity and impact, consultation behavior, treatments commenced, and psychological health. We examined whether subsequent disease behavior in Rome IV- or Rome III-defined IBS differed.
At 12 months, 638 (58.2%) of the 1097 participants were followed up successfully. Of these, 452 met Rome IV criteria and 186 met Rome III criteria at baseline. During the 12-month study period, individuals with Rome IV IBS were significantly more likely to have seen a primary care physician (44.7% vs 28.5%; P < .001) or a gastroenterologist (26.3% vs 12.4%; P < .001) for their IBS symptoms, were significantly more likely to have commenced a new treatment (73.0% vs 60.2%; P = .001), and cycled through significantly more treatments (P = .007), for their IBS compared with those with Rome III IBS. At follow-up evaluation, individuals with Rome IV IBS had more severe symptoms, which had a significantly greater impact on activities of daily living, were more likely to report continuous abdominal pain, and a higher proportion showed poor psychological health, compared with those with Rome III IBS (P < .001 for all analyses).
The natural history of IBS defined according to Rome IV criteria is more severe than that of Rome III-defined IBS. This has important implications for future treatment trials in IBS.
肠易激综合征（IBS）是一种根据罗马标准诊断的慢性功能性肠病，自30年前首次描述以来，该标准一直在演变。对于从先前的罗马III标准过渡到最新版本罗马IV标准对IBS自然病程的影响知之甚少。我们进行了一项为期12个月的纵向随访研究来对此进行调查。
我们从1097名自我认定患有IBS且符合罗马IV或罗马III标准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。在12个月时，我们收集了有关IBS症状严重程度和影响、就诊行为、开始的治疗以及心理健康的数据。我们研究了罗马IV或罗马III定义的IBS中后续疾病行为是否存在差异。
1097名参与者中有638名（58.2%）在12个月时成功接受了随访。其中，452名在基线时符合罗马IV标准，186名符合罗马III标准。在为期12个月的研究期间，与罗马III型IBS患者相比，罗马IV型IBS患者因IBS症状看初级保健医生（44.7%对28.5%；P <.001）或胃肠病学家（26.3%对12.4%；P <.001）的可能性显著更高，开始新治疗的可能性显著更高（73.0%对60.2%；P =.001），并且接受的IBS治疗周期显著更多（P =.007）。在随访评估中，与罗马III型IBS患者相比，罗马IV型IBS患者症状更严重，对日常生活活动的影响显著更大，更有可能报告持续性腹痛，且心理健康状况较差的比例更高（所有分析的P <.001）。
根据罗马IV标准定义的IBS自然病程比罗马III标准定义的更严重。这对未来IBS的治疗试验具有重要意义。
