Functional gastrointestinal disorders in children: agreement between Rome III and Rome IV diagnoses

Area of Science:

• Pediatric Gastroenterology
• Clinical Epidemiology
• Diagnostic Criteria Evaluation

Background:

• The Rome IV criteria represent an update to the Rome III criteria for diagnosing functional gastrointestinal disorders (FGIDs) in children and adolescents.
• Previous studies suggest potential discrepancies in FGID prevalence between Rome III and Rome IV, with possible confounding factors like temporal changes or sample variations.
• Understanding the agreement between these diagnostic criteria is crucial for accurate diagnosis and epidemiological assessment of pediatric FGIDs.

Purpose of the Study:

• To prospectively evaluate the diagnostic agreement between the Rome III and Rome IV criteria for pediatric functional gastrointestinal disorders (FGIDs).
• To compare the prevalence of FGIDs and specific subtypes, such as functional constipation and functional dyspepsia, using both Rome III and Rome IV criteria in a pediatric cohort.

Main Methods:

• A prospective cohort study was conducted in a public school in Cali, Colombia, involving children and adolescents aged 11-18 years.
• Participants completed the Spanish version of the Questionnaire on Pediatric Functional Gastrointestinal Disorders, first using Rome III criteria (Day 0) and then Rome IV criteria (Day 2).
• Data from 96 participants who correctly completed both questionnaires were analyzed to assess diagnostic agreement (kappa statistic) and prevalence differences.

Main Results:

• A minimal agreement (kappa = 0.34, 70% agreement) was observed between Rome III and Rome IV criteria for diagnosing any FGID.
• Fewer children met the criteria for an FGID under Rome IV (29.2%) compared to Rome III (40.6%), though this difference was not statistically significant (p=0.063).
• Significant differences in prevalence were found for specific FGIDs: functional constipation was lower with Rome IV (13.5% vs 31.3%, p<0.001), while functional dyspepsia was higher (11.5% vs 0%, p<0.001).

Conclusions:

• There is a minimal agreement in diagnosing pediatric FGIDs between the Rome III and Rome IV criteria, particularly for functional constipation, irritable bowel syndrome, and functional dyspepsia.
• Discrepancies in diagnostic criteria between Rome IV and Rome III likely contribute to the observed low agreement and varying prevalence rates.
• Limitations inherent in using questionnaires for prevalence measurement should be considered when interpreting these findings.