Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Gastroenterology. 2023 Jun;164(7):1211-1222. doi: 10.1053/j.gastro.2023.02.033. Epub 2023 Mar 6.
BACKGROUND & AIMS: The Rome criteria are widely accepted for diagnosing disorders of gut-brain interaction, but their global applicability has been debated. This study aimed to evaluate the validity of the Rome IV criteria by factor analysis globally, across geographical regions, by sex, and by age groups.
Data were collected in 26 countries using the Rome IV questionnaire. Forty-nine ordinal variables were used in exploratory factor analysis (EFA) to identify clusters of inter-correlated variables (factors) within the data set. Confirmatory factor analysis with predefined factors of the disorders of gut-brain interaction was compared with the factors in the EFA. Analyses were performed globally, for each geographical region (North and Latin America, Western and Eastern Europe, Middle East, Asia), sex, and age groups (18-34, 35-49, 50-64, ≥65).
A total of 54,127 people were included. The EFA identified 10 factors accounting for 57% of the variance: irritable bowel syndrome, constipation, diarrhea, upper gastrointestinal symptoms, globus, regurgitation/retching, chest pain, nausea/vomiting, and 2 right upper quadrant pain factors. Most factors had close correspondence to a Rome IV criteria diagnosis, but notably, functional dysphagia and heartburn symptoms were often included in the same factor and/or in upper gastrointestinal symptoms. Most factors were consistent across geographical regions, sex, and age groups, and compatible to the global results. All prespecified factors in the confirmatory analysis had a loading ≥0.4, indicating validity of the Rome IV criteria.
The results indicate that the Rome IV criteria for irritable bowel syndrome, functional dyspepsia, functional constipation, globus, and biliary pain are globally valid and represent universal diagnostic entities that are similar across sex and age groups.
罗马标准被广泛用于诊断肠-脑相互作用障碍，但它们的全球适用性存在争议。本研究旨在通过全球、地理区域、性别和年龄组的因子分析评估罗马 IV 标准的有效性。
使用罗马 IV 问卷在 26 个国家收集数据。49 个有序变量用于探索性因子分析（EFA），以识别数据集内相互关联变量（因子）的聚类。对肠-脑相互作用障碍的预定义因子进行验证性因子分析，并与 EFA 中的因子进行比较。分析在全球范围内进行，针对每个地理区域（北美和拉丁美洲、西欧和东欧、中东、亚洲）、性别和年龄组（18-34 岁、35-49 岁、50-64 岁、≥65 岁）进行。
共纳入 54127 人。EFA 确定了 10 个因子，占总方差的 57%：肠易激综合征、便秘、腹泻、上胃肠道症状、球感、反流/呕吐、胸痛、恶心/呕吐，以及 2 个右上腹痛因子。大多数因子与罗马 IV 标准诊断密切相关，但值得注意的是，功能性吞咽困难和烧心症状通常包含在同一因子和/或上胃肠道症状中。大多数因子在地理区域、性别和年龄组之间具有一致性，与全球结果一致。验证性分析中所有预设因子的负荷≥0.4，表明罗马 IV 标准的有效性。
结果表明，罗马 IV 标准对肠易激综合征、功能性消化不良、功能性便秘、球感和胆石痛的诊断具有全球有效性，代表了在性别和年龄组之间相似的普遍诊断实体。
