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Classification of pediatric functional gastrointestinal disorders related to abdominal pain using Rome III vs. Rome
Trent Edwards1, Craig Friesen2, Jennifer V Schurman3
1Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA.
Insights
The Rome IV criteria significantly increased diagnoses for functional dyspepsia (FD), irritable bowel syndrome (IBS), and their overlap in children with chronic abdominal pain compared to Rome III. Further research is needed to link these diagnoses to treatment outcomes.
Area of Science:
- Pediatric Gastroenterology
- Functional Gastrointestinal Disorders
- Diagnostic Criteria Evaluation
Background:
- Chronic abdominal pain in children is often associated with functional gastrointestinal disorders.
- Existing diagnostic criteria, such as Rome III and Rome IV, evolve to better classify these conditions.
- Comparing these criteria is essential for accurate diagnosis and management.
Purpose of the Study:
- To compare the diagnostic frequencies of Irritable Bowel Syndrome (IBS) and Functional Dyspepsia (FD) using Rome III versus Rome IV criteria in pediatric patients.
- To assess the prevalence of FD/IBS overlap syndrome under both criteria sets.
- To determine the frequencies of Rome IV FD subtypes (PDS, EPS) and analyze symptom associations in the overlap group.
Main Methods:
- A retrospective chart review of 106 pediatric patients (8-17 years) with chronic abdominal pain was conducted.
- Patients with diagnosed gastrointestinal diseases were excluded.
- A single pediatric gastroenterologist applied Rome III and Rome IV criteria for diagnosis.
Main Results:
- Rome IV criteria led to significantly higher diagnoses of FD (84.9% vs. 52.8%), IBS (69.8% vs. 34%), and FD/IBS overlap (58.5% vs. 17.9%) compared to Rome III.
- Rome IV identified PDS in 81.1%, EPS in 11.1%, and both in 6.7% of FD cases.
- The overlap group showed increased diarrhea frequency with Rome IV, and diarrhea/pain with eating with Rome III.
Conclusions:
- Rome IV criteria result in a substantial increase in FD, IBS, and FD/IBS overlap diagnoses in children compared to Rome III.
- Rome IV criteria may lead to greater heterogeneity within diagnostic categories.
- Future research should investigate if Rome IV diagnoses predict treatment response and if symptom variability assessment improves treatment selection.
Background:
The primary purpose of this study was to compare Rome III and IV evaluation criteria for irritable bowel syndrome (IBS), functional dyspepsia (FD), and an overlap syndrome consisting of both IBS and FD by assessing the frequency of each diagnosis in a population of children with chronic abdominal pain. Frequencies of Rome IV FD subtypes of postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) were determined and FD/IBS overlap symptom associations were also assessed.
Methods:
We conducted a cross-sectional retrospective chart review of 106 pediatric patients who had completed standardized medical histories as part of their evaluation for chronic abdominal pain. The patients ranged from eight to 17 years of age and reported having abdominal pain at least weekly for 8 weeks. Patients whose evaluation revealed gastrointestinal disease were excluded. The patients' diagnoses were determined by a single pediatric gastroenterologist utilizing the specific criteria for Rome III and IV, respectively.
Results:
Patients were significantly more likely to be diagnosed with FD (84.9% vs. 52.8%), IBS (69.8% vs. 34%), and FD/IBS overlap (58.5% vs. 17.9%) by Rome IV criteria, as compared to Rome III criteria. With regard to Rome IV FD subtypes, 81.1% fulfilled criteria for PDS, 11.1% fulfilled criteria for EPS, 6.7% fulfilled criteria for both, and 1.1% did not fulfill criteria for either. Finally, we found an increased frequency of diarrhea and pain with eating in the overlap group compared to the non-overlap group of Rome III, while only an increased frequency of diarrhea was found in the overlap group compared to the non-overlap group of Rome IV.
Conclusions:
Our data demonstrate that utilizing Rome IV criteria, as compared to Rome III, results in an increase in the diagnosis of FD, a two-fold increase in the diagnosis of IBS, and a three-fold increase in the diagnosis of FD/IBS overlap. Rome IV criteria appears to result in greater heterogeneity within diagnostic categories. It is important to determine whether Rome IV diagnoses are predictive of treatment response, and if so, whether assessing symptom variability within a diagnosis will enhance the ability to select patients for a particular treatment.
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