Symptom Patterns Outside the Rome IV Consensus in Eastern and Western Patients With a Disorder of Gut-Brain...

Area of Science:

• Gastroenterology
• Neurogastroenterology
• Functional Gastrointestinal Disorders

Background:

• The Rome criteria classify disorders of gut-brain interaction (DGBI) based on symptom origin within specific gastrointestinal (GI) anatomical regions.
• Previous research in Asian DGBI patients indicated symptom clusters spanning multiple anatomical areas.
• This study aimed to determine if such multi-regional DGBI symptom groupings exist in both Eastern and Western populations.

Purpose of the Study:

• To investigate the existence of DGBI symptom groupings that involve more than one anatomical region in both Eastern and Western patients.
• To identify distinct DGBI symptom clusters using a validated questionnaire.
• To compare identified symptom clusters with the existing Rome IV diagnostic criteria.

Main Methods:

• Recruitment of physician-diagnosed DGBI patients from 5 Eastern and 6 Western centers.
• Administration of the Enhanced Asian Rome questionnaire (EAR4Q) to all participants.
• Application of exploratory and confirmatory factor analysis to identify and describe distinct DGBI symptom groupings.

Main Results:

• 1074 DGBI patients (66.8% female, mean age 42.6 years) were analyzed.
• Ten distinct symptom groupings were identified, including IBS-D, constipation, upper GI symptoms, and combined upper/lower GI symptoms.
• Several identified symptom groupings encompassed multiple anatomical regions, extending beyond the limitations of the Rome criteria's regional subdivision approach.

Conclusions:

• The study identified 10 distinct symptom clusters in DGBI patients across Eastern and Western populations.
• Some identified clusters aligned with Rome criteria, while others integrated symptoms from multiple anatomical regions.
• These findings challenge the anatomical basis of the Rome classification and highlight the complex, multi-regional nature of DGBI symptom patterns.