Saudi Journal of Gastroenterology
Home About us Instructions Submission Subscribe Advertise Contact Login    Print this page  Email this page Small font sizeDefault font sizeIncrease font size 
Users Online: 1507 


 
EDITORIAL Table of Contents   
Year : 2010  |  Volume : 16  |  Issue : 3  |  Page : 143-144
The Rome criteria divides, distorts and dilutes the prevalence of irritable bowel syndrome


1 Stomach Liver and Bowel Clinic, Gleneagles Hospital, Singapore
2 Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Click here for correspondence address and email

Date of Web Publication7-Jul-2010
 

How to cite this article:
Gwee KA, Ghoshal UC. The Rome criteria divides, distorts and dilutes the prevalence of irritable bowel syndrome. Saudi J Gastroenterol 2010;16:143-4

How to cite this URL:
Gwee KA, Ghoshal UC. The Rome criteria divides, distorts and dilutes the prevalence of irritable bowel syndrome. Saudi J Gastroenterol [serial online] 2010 [cited 2019 Dec 6];16:143-4. Available from: http://www.saudijgastro.com/text.asp?2010/16/3/143/65178


Functional bowel disorders (FBD) comprise a group of conditions that continue to challenge and defy clear definition and understanding. Patients experience a variable combination of gastrointestinal symptoms for which there is no organic basis that can be identified by routine medical tests. Functional bowel disorders are not life threatening, but its treatment is time consuming. As discussed in the paper from Iran by Sorouri et al, the reported prevalence worldwide is between 12 and 42%, and in Iran, FBDs make up 40% of gastroenterology outpatients. [1]

Therefore, it is surprising that in this well conducted study involving 18180 participants from Tehran province, Iran, the prevalence of the irritable bowel syndrome (IBS) (the most well studied of the FBD) was only 1.1%. [1] On the other hand, the prevalence of all FBDs, while modest, was still substantial at 10.9%. These numbers recall the low numbers reported in the study from Israel where the prevalence of IBS was only 2.9% when this was based on the Rome II criteria. [2] Another notable aspect of this new Iranian study was the high degree of overlap between FBD and functional dyspepsia; 83.8% of dyspepsia had FBD, and 68.5% of FBD had dyspepsia. [1] This situation is very similar to what we have observed in the rest of Asia. [3] We have observed that Asian patients may present with upper abdominal symptoms more often than Western population. [3],[4],[5] We have identified a number of studies from Asia, where it appeared that subjects with IBS may have been misclassified as suffering from dyspepsia. [3],[6],[7] In a study from Taiwan, more than half of patients initially classified as suffering from dyspepsia were reclassified as IBS when it was clarified that their upper abdominal pain was exclusively relieved with defecation. [6]

How do we make sense of all these numbers? In the study by Sperber et al, it was observed that a simple change in the definition allowing for milder symptoms to qualify for IBS, increased its prevalence almost four times in the same cohort, but the prevalence of FBD remained the same. [8] This suggests that the division of FBD into the various subsets is arbitrary, and in the process, produces distortion in the recognition of IBS. In the current Iranian study, there appears to be a similar distortion by the vagaries of the Rome criteria. Unspecified FBD (U-FBD) comprised the largest group of FBD, suggesting that there is a substantial group of subjects with FBD who just failed to meet the criteria for IBS. In U-FBD, bloating (64.4%) was more common than abdominal pain (46.7%). [1] U-FBD subjects also had the highest overlap with functional dyspepsia. We have argued that bloating should be recognized as one of the major symptoms of IBS, and it should also be recognized that IBS symptoms frequently occur after meals. [3] In a recent major Indian survey, the symptoms of IBS patients were studied unencumbered by the Rome criteria, and it was observed that abdominal fullness (bloating) was as common as abdominal pain (70% of 2785 patients). [4]

In their conclusions, the authors of this paper have appropriately highlighted issues with the Rome criteria itself. [1] It is timely that the Rome Foundation takes a more global perspective. To do so, more attention should be paid to the influence of culture on symptom reporting and therein, interpretation of gastrointestinal symptoms, and how this could affect the workup and diagnosis of functional GI diagnosis of FBDs worldwide. While the Rome criteria provide a useful yardstick for pharmaceutical industry and regulatory authorities, in our scientific exploration we should not homogenize for the sake of homogenizing. The underlying risk associated with this is losing potentially valuable clues that can help us to understand FBDs better. However, ultimately, it is still up to researchers in various parts of the world to stand up and be counted, as the authors of this Iranian study and others have recently done. [4]

 
   References Top

1.Sorouri M, Pourhoseingholi MA, Vahedi M, Safaee A, Dehkordi BM, Pourhoseingholi A, et al. Functional bowel disorders in Iranian population using rome III. Saudi J Gastroenterol 2010;16:154-60.  Back to cited text no. 1  [PUBMED]  Medknow Journal  
2.Sperber AD, Shvartzman P, Friger M, Fich A. Unexpectedly low prevalence rates of IBS among adult Israeli Jews. Neurogastroenterol Motil 2005;17:207-11.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Gwee KA, Lu CL, Ghoshal UC. Epidemiology of irritable bowel syndrome in Asia: Something old, something new, something borrowed. J Gastroenterol Hepatol 2009;24:1601-7.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]  
4.Ghoshal UC, Abraham P, Bhatt C, Choudhuri G, Bhatia SJ, Shenoy KT, et al. Epidemiological and clinical profile of irritable bowel syndrome in India: Report of the Indian Society of Gastroenterology Task Force. Indian J Gastroenterol 2008;27:22-8.  Back to cited text no. 4  [PUBMED]    
5.Masud MA, Hasan M, Khan AK. Irritable bowel syndrome in a rural community in Bangladesh: Prevalene, symptoms pattern, and health care seeking behavior. Am J Gastroenterol 2001;96:1547-52.   Back to cited text no. 5  [PUBMED]    
6.Lu CL, Lang HC, Chang FY, Chen CY, Luo JC, Wang SS, et al. Prevalence and health/social impacts of functional dyspepsia in Taiwan: A study based on the Rome criteria questionnaire survey assisted by endoscopic exclusion among a physical check-up population. Scand J Gastroenterol 2005;40:402-11.  Back to cited text no. 6  [PUBMED]    
7.Ho KY, Kang JY, Seow A. Prevalence of gastrointestinal symptoms in a multiracial Asian population, with particular reference to reflux-type symptoms. Am J Gastroenterol 1998;93:1816-22.   Back to cited text no. 7  [PUBMED]    
8.Sperber AD, Shvartzman P, Friger M, Fich A. A comparative reappraisal of the Rome II and Rome III diagnostic criteria: Are we getting closer to the 'true'prevalence of irritable bowel syndrome? Eur J Gastroenterol Hepatol 2007;19:441-7.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]  

Top
Correspondence Address:
Kok-Ann Gwee
Gleneagles Hospital, Annexe Block #05-37, 6A Napier Road, Singapore

Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-3767.65178

Rights and Permissions



This article has been cited by
1 Update on Irritable Bowel Syndrome Program of Research
Margaret Heitkemper,Monica Jarrett,Sang-Eun Jun
Journal of Korean Academy of Nursing. 2013; 43(5): 579
[Pubmed] | [DOI]
2 A global perspective on irritable bowel syndrome: A consensus statement of the world gastroenterology organisation summit task force on irritable bowel syndrome
Quigley, E.M.M. and Abdel-Hamid, H. and Barbara, G. and Bhatia, S.J. and Boeckxstaens, G. and De Giorgio, R. and Delvaux, M. and Drossman, D.A. and Foxx-Orenstein, A.E. and Guarner, F. and Gwee, K.-A. and Harris, L.A. and Hungin, A.P.S. and Hunt, R.H. and Kellow, J.E. and Khalif, I.L. and Kruis, W. and Lindberg, G. and Olano, C. and Moraes-Filho, J.P. and Schiller, L.R. and Schmulson, M. and Simrén, M. and Tzeuton, C.
Journal of Clinical Gastroenterology. 2012; 46(5): 356-366
[Pubmed]
3 A Global Perspective on Irritable Bowel Syndrome
Eamonn M. M. Quigley,Hussein Abdel-Hamid,Giovanni Barbara,Shobna J. Bhatia,Guy Boeckxstaens,Roberto De Giorgio,Michel Delvaux,Douglas A. Drossman,Amy E. Foxx-Orenstein,Francisco Guarner,Kok-Ann Gwee,Lucinda A. Harris,A. Pali S. Hungin,Richard H. Hunt,John E. Kellow,Igor L. Khalif,Wolfgang Kruis,Greger Lindberg,Carolina Olano,Joaquim P. Moraes-Filho,Lawrence R. Schiller,Max Schmulson,Magnus Simrén,Christian Tzeuton
Journal of Clinical Gastroenterology. 2012; 46(5): 356
[Pubmed] | [DOI]
4 Prevalence of Irritable Bowel Syndrome: A Community Based Study From Northern India
Govind K Makharia,Anil K Verma,Ritvik Amarchand,Anil Goswami,Prashant Singh,Abhishek Agnihotri,Faizul Suhail,Anand Krishnan
Journal of Neurogastroenterology and Motility. 2011; 17(1): 82
[Pubmed] | [DOI]
5 Low prevalence of functional bowel disorders in Iranian population using Rome III
Pourhoseingholi, M.A. and Sorouri, M.
Gastroenterology and Hepatology from Bed to Bench. 2011; 4(1): 38-39
[Pubmed]
6 Prevalence of irritable bowel syndrome: A community based study from northern India
Makharia, G.K. and Verma, A.K. and Amarchand, R. and Goswami, A. and Singh, P. and Agnihotri, A. and Suhail, F. and Krishnan, A.
Journal of Neurogastroenterology and Motility. 2011; 17(1): 82-87
[Pubmed]



 

Top
 
  Search
 
  
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  


    References

 Article Access Statistics
    Viewed3093    
    Printed198    
    Emailed0    
    PDF Downloaded622    
    Comments [Add]    
    Cited by others 6    

Recommend this journal