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The interpretation of Rome III criteria and method of assessment affect the irritable bowel syndrome classification
D I Czyzewski1, M M Lane, E M Weidler
1Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. danitac@bcm.edu
Insights
Classifying pediatric irritable bowel syndrome (IBS) is challenging due to differing parent and child reports. This study found poor agreement between methods, highlighting the need for clearer Rome III criteria and better parent-child communication.
Area of Science:
- Pediatric Gastroenterology
- Clinical Trial Methodology
- Symptom Classification Systems
Background:
- Pediatric irritable bowel syndrome (IBS) diagnosis is complex, influenced by discrepancies between parent and child reports.
- Interpreting pain-stool relationships within the Rome III classification system presents challenges for accurate pediatric IBS diagnosis.
Purpose of the Study:
- To compare the classification of pediatric irritable bowel syndrome (IBS) using diary methods versus child and parent respondent reports.
- To evaluate the congruence and discrepancies between different IBS classification approaches in children.
Main Methods:
- A study involving 90 children (ages 7-10) with recurrent abdominal pain and their parents.
- Utilized IBS symptom questionnaires and 2-week pain/stool diaries, coded with individual and normative algorithms.
- Employed Chi-squared tests to analyze dichotomous classifications (IBS vs. not IBS) between methods and respondents.
Main Results:
- Individual and normative diary classifications showed 62% congruence, with the individual method identifying more IBS cases (53% vs. 18%).
- Parent and child questionnaire reports demonstrated no significant correlation.
- The most congruent pairing was normative diary classifications with parent questionnaires (76% agreement).
Conclusions:
- The poor congruence among various IBS classification methods indicates a need for improved specification of Rome III criteria.
- Enhancing agreement between parent and child reporting is crucial for accurate pediatric IBS diagnosis.
Background:
Paediatric classification of irritable bowel syndrome (IBS) is complicated by the potential discrepancy between parent and child report and by the interpretation of pain-stool relations in the Rome III classification system.
Aim:
To compare IBS classification by diary and by child and parent respondents.
Methods:
Children (ages 7-10 years, n = 90) with recurrent abdominal pain and their parents completed IBS symptom questionnaires and 2-week pain and stool diaries. Diaries were coded with two algorithms, one defining stool changes individually and one defining changes normatively. Proportions of dichotomous classifications (IBS vs. not IBS) between pairs of classification methods/respondents were evaluated using Chi-squared tests (χ²) to determine whether coding methods were significantly related, the degree of inclusiveness, and whether differences in classification were randomly distributed.
Results:
Individual and normative diary classifications were congruent in 62% of cases, but the individual method classified more children with IBS, 53% vs. 18%. Parent and child questionnaire reports were not correlated. The normative diary classifications and parent questionnaire were the most congruent pair of methods (76% of cases).
Conclusions:
Poor congruence among methods suggests that Rome III IBS criteria need better specification, and efforts to improve parent-child agreement are necessary.
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