Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
Sheikh Russel National Gastroliver Institute and Hospital, Dhaka, Bangladesh.
Neurogastroenterol Motil. 2023 Jun;35(6):e14579. doi: 10.1111/nmo.14579. Epub 2023 Apr 3.
Although the Rome IV criteria are the most recent criteria to diagnose irritable bowel syndrome (IBS), their sensitivity has been shown to be low in Chinese and Western populations. There are scanty data comparing the Rome III and Rome IV criteria in diagnosis of IBS in the Indian and Bangladeshi populations where abdominal pain, an essential component of diagnosis of IBS by the Rome IV criteria, is less in frequency and of lower severity.
We analyzed the Indian and Bangladeshi data from the Rome Global Epidemiology Study to compare diagnostic sensitivity of the Rome III and Rome IV criteria for IBS, internal shifts in diagnostic categories of disorders of gut-brain interaction (DGBI), the severity of IBS diagnosed by the Rome III and Rome IV criteria, and consultation patterns in these populations.
The Rome IV criteria were less sensitive than the Rome III criteria to diagnose IBS in these populations, and the subjects with Rome III IBS shifted internally to other DGBI when the Rome IV criteria were applied. Moreover, Rome IV IBS subjects had greater symptom severity than the Rome III IBS. A third of people fulfilling diagnostic criteria for IBS consulted doctors, and those diagnosed using Rome IV criteria, those with higher anxiety and depression symptom score, lower global physical health score, and greater IBS symptom severity score had greater correlation coefficients with doctors' consultation.
The Rome IV diagnostic criteria for IBS are less sensitive than the Rome III criteria in Indian and Bangladesh communities. Application of the Rome IV criteria to people who meet the Rome III IBS criteria selects a subgroup of people with greater severity of symptoms, and hence, Rome IV IBS is more strongly associated with physician consultation. These findings may have important bearing in future iterations of the Rome criteria for a broader global applicability.
尽管 Rome IV 标准是诊断肠易激综合征（IBS）的最新标准，但已证明其在中西方人群中的敏感性较低。在印度和孟加拉国人群中，Rome III 和 Rome IV 标准在 IBS 诊断中的比较数据很少，Rome IV 标准中诊断 IBS 的必要组成部分——腹痛，其频率较低，严重程度较低。
我们分析了 Rome 全球流行病学研究中的印度和孟加拉国数据，以比较 Rome III 和 Rome IV 标准诊断 IBS 的敏感性、肠脑互动障碍（DGBI）诊断类别的内部转移、Rome III 和 Rome IV 标准诊断的 IBS 严重程度以及这些人群的咨询模式。
Rome IV 标准在这些人群中诊断 IBS 的敏感性低于 Rome III 标准，Rome III IBS 患者在应用 Rome IV 标准时会转移到其他 DGBI 中。此外，Rome IV IBS 患者的症状严重程度大于 Rome III IBS 患者。三分之一符合 IBS 诊断标准的人会咨询医生，那些符合 Rome IV 标准的人、那些焦虑和抑郁症状评分较高、整体身体健康评分较低、IBS 症状严重程度评分较高的人，与医生咨询的相关性系数更大。
Rome IV 诊断 IBS 的标准在印度和孟加拉国社区中不如 Rome III 标准敏感。Rome IV 标准应用于符合 Rome III IBS 标准的人群中，选择了一组症状更严重的人群，因此，Rome IV IBS 与医生咨询的相关性更强。这些发现可能对未来 Rome 标准的迭代具有重要意义，以实现更广泛的全球适用性。
