Functional defecation disorders in children: comparing the Rome II with the Rome III criteria

Area of Science:

• Pediatric Gastroenterology
• Clinical Research
• Diagnostic Criteria Evaluation

Background:

• Functional defecation disorders (FDD) are common in children.
• Accurate diagnosis relies on standardized criteria, such as the Rome criteria.
• Previous versions of Rome criteria may have limitations in capturing the full spectrum of pediatric FDD.

Purpose of the Study:

• To determine the prevalence of pediatric FDD using Rome III criteria.
• To compare FDD prevalence between Rome III and Rome II criteria.
• To assess the impact of Rome III criteria on the diagnosis of functional constipation (FC) and functional fecal incontinence (FFI) in children.

Main Methods:

• Chart review of patients referred to a tertiary outpatient clinic for constipation and/or fecal incontinence.
• Standardized bowel questionnaires and physical examinations, including rectal examination, were administered.
• Prevalence of pediatric FDD was calculated using both Rome II and Rome III criteria.

Main Results:

• Out of 336 patients with FDD, 87% met Rome III criteria for functional constipation (FC), compared to only 34% meeting Rome II criteria for FC or functional fecal retention (P < .001).
• Fecal incontinence was present in 75% of patients, and 49% had a palpable rectal fecal mass.
• Functional nonretentive fecal incontinence was diagnosed in 11% of patients by both criteria sets.

Conclusions:

• The Rome III criteria for pediatric FC are less restrictive than Rome II criteria.
• Rome III criteria represent a significant improvement in defining and recognizing FDD in children.
• The findings support the broader application of Rome III criteria for accurate FDD diagnosis.