About four in 10 adults across 15 countries met criteria for at least one disorder of gut-brain interaction (DGBI) under the new Rome V criteria, nearly the same proportion identified using Rome IV, according to a multinational population survey.
The findings, published in Gut, provide an early global look at the new Rome V criteria and suggest that changes to individual diagnostic definitions had little effect on the overall prevalence of these disorders. Investigators also examined how bothersome symptoms were and how much they interfered with daily life to help develop diagnostic criteria that better reflect their clinical impact.
“One of the highlights of this new study is its comparison with the previous Rome Foundation Global Epidemiology Study (Rome IV),” Ami D. Sperber, MD, of Ben-Gurion University of the Negev in Israel, told GI & Hepatology News. “The two studies, conducted seven years apart, had the identical rigorous methodology and the same 22 DGBI were surveyed in the same 15 countries with worldwide distribution. Thus, it was both intriguing and of great potential significance to compare the results of the two studies.”
Dr. Sperber and colleagues surveyed 28,771 adults online across 15 countries. About 2,000 participants were recruited from each country, with quotas to ensure representation by sex and age. The survey included the Rome V diagnostic questionnaire, along with questions about health care use and other clinical factors.
For the comparison with the earlier survey, investigators analyzed prevalence estimates for disorders assessed under both Rome IV and Rome V criteria. The data were weighted to account for differences in sample size among countries.
Based on the 22 disorders assessed in both surveys, the prevalence of at least one DGBI was 40.9% under Rome V and 40.5% under Rome IV. Including all 25 disorders assessed under Rome V raised the overall figure only slightly, to 41.4%. Women were more likely than men to meet criteria, 46.9% vs. 34.8%. Prevalence also declined with age, from 45.9% among adults aged 18-34 years to 33.3% among those aged 65 years or older.
Bowel disorders remained the most common category, affecting 34.7% of participants under Rome V vs. 33.9% under Rome IV. Unclassified bowel disorder was the most common bowel disorder, affecting 9.6%, followed by chronic constipation at 8.9% and irritable bowel syndrome (IBS) at 8.5%. Functional dyspepsia was the most common gastroduodenal disorder at 8.1%, proctalgia fugax the most common anorectal disorder at 7.3%, and functional dysphagia the most common esophageal disorder at 4.1%.
Some diagnoses changed substantially under the new criteria. IBS prevalence more than doubled, from 3.9% under Rome IV to 8.5% under Rome V. The authors attributed much of the increase to changes in the criteria, including lowering the minimum frequency of abdominal pain to three days per month and again including abdominal discomfort as a qualifying symptom. Chronic constipation — termed functional constipation under Rome IV — declined from 11.8% to 8.9%, which the authors said likely reflects an internal shift as more people with constipation-type symptoms met IBS criteria.
Functional dyspepsia increased from 6.9% under Rome IV to 8.1% under Rome V, while rumination syndrome declined from 2.8% to 1.5%. Fecal incontinence increased from 1.7% to 4.1%; the authors attributed the increase largely to Rome V lowering the required frequency of episodes from twice a month to once a month.
Rome V also added abdominal migraine and inability to belch syndrome as disorders in adults, affecting 5.1% and 1.4% of participants, respectively. More than 90% of those with abdominal migraine and more than 95% of those with inability to belch syndrome also met criteria for another disorder. As a result, adding these diagnoses contributed little to overall prevalence.
Among participants with at least one disorder, 42.6% had ever seen a physician for a GI problem, 39% said their symptoms were at least moderately bothersome, and 28.1% said symptoms interfered at least moderately with daily life. In an analysis adjusted for age and sex, the authors reported that bothersomeness was more strongly associated with having consulted a doctor than life interference was, with odds ratios of 3.53 and 2.25, respectively.
Participants with painful disorders more often reported physician visits than those with nonpainful disorders, 54.4% vs. 43.2%; bothersome symptoms, 56.1% vs. 39.9%; and interference with daily life, 42.4% vs. 29.2%.
Limitations included the lack of diagnostic testing, reliance on self-reported symptoms, and the possibility of selection and recall bias. The study also included fewer countries than the earlier survey (15 vs. 26 in the internet arm of the Rome IV survey) and relatively few participants from rural areas, which may limit how broadly the findings apply.
The study was conducted and funded by the Rome Foundation Research Institute. The authors reported no competing interests.
Expert Insight
Dr. Sperber shared his perspective on the study with GI & Hepatology News.
How might the Rome V criteria change the way gastroenterologists diagnose and manage IBS in clinical practice?
Dr. Sperber: The Rome V criteria re-introduced abdominal discomfort as a diagnostic criterion (alongside abdominal pain) and lowered the minimum frequency of pain/discomfort required for diagnosis compared to Rome IV criteria. These changes bring the Rome V criteria more into alignment with how IBS is commonly diagnosed in clinical practice. That may improve acceptance of the Rome criteria by clinicians, some of whom have felt that the Rome IV criteria were too stringent and excluded many patients who likely had IBS. With aim of developing specific clinical criteria that will be easy for clinicians to adopt and use globally, three new variables, i.e., bothersomeness of symptoms, interference of symptoms with life function, and perceived need to consult with a doctor for the symptoms were introduced in the Rome V global study after they were validated in focus groups. Thus, a groundwork was laid in this study for clinicians to benefit more from the Rome criteria in clinical practice.
Should symptom bothersomeness and life interference play a greater role in diagnosing and treating DGBI?
Dr. Sperber: These two new variables that were reported first in the present study are, together with the perceived need to consult with a doctor, factors that can have a strong effect on the patient’s perspective on their illness and the impact on their daily functioning and quality of life. Thus, these are important foundations for future clinical diagnostic criteria for DGBI and for the doctor’s ability to develop a multidimensional clinical profile of the patient, which will facilitate working with patients to develop a patient-centered treatment plan and follow-up.
What should gastroenterologists know about the newly recognized Rome V disorders, particularly abdominal migraine and inability to belch syndrome?
Dr. Sperber: These two newly defined DGBI diagnoses were shown, in this study, to be considerably prevalent in the general population at a rate of 5.1% for abdominal migraine and 1.4% for inability to belch. They were also found, in most cases, to overlap with other DGBI. Where they co-exist with other DGBI, they likely add to the disease burden, because DGBI overlap has been associated, in papers from the Rome IV global epidemiological study, with greater psychosocial distress, higher disease severity, higher rates of somatization, and lower quality of life. Gastroenterologists should be more aware of these additional entities, their diagnosis and care. There were other new diagnoses introduced in Rome V as well, e.g., rectal hypo- and hypersensitivity, but these require both clinical recognition and laboratory testing for confirmation, so they were not included in the present survey.