Inability of the Rome III Criteria to Distinguish... : Official journal of the American College of Gastroenterology | ACG (original) (raw)

ORIGINAL CONTRIBUTIONS: FUNCTIONAL GI DISORDERS

Inability of the Rome III Criteria to Distinguish Functional Constipation From Constipation-Subtype Irritable Bowel Syndrome

Wong, Reuben K MD1,2; Palsson, Olafur S PsyD2; Turner, Marsha J MS2; Levy, Rona L PhD, MPH3; Feld, Andrew D MD, JD4; von Korff, Michael PhD5; Whitehead, William E PhD2

1Department of Gastroenterology and Hepatology, National University Hospital, National University Healthcare System, Singapore

2Center for Functional GI and Motility Disorders, and Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA

3School of Social Work, University of Washington, Seattle, Washington, USA

4Division of Gastroenterology, University of Washington, and Group Health Cooperative, Seattle, Washington, USA

5Group Health Research Institute, Group Health Cooperative, Seattle, Washington, USA

Correspondence: William E. Whitehead, PhD, Professor of Medicine and Adjunct Professor of OBGYN, Co-Director of UNC Center for Functional GI and Motility Disorders, Campus Box 7080, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7080, USA. E-mail: [email protected]

published online 25 May 2010

Received 19 November 2009; accepted 8 April 2010

Abstract

OBJECTIVES:

The Rome III classification system treats functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C) as distinct disorders, but this distinction appears artificial, and the same drugs are used to treat both. This study's hypothesis is that FC and IBS-C defined by Rome III are not distinct entities.

METHODS:

In all, 1,100 adults with a primary care visit for constipation and 1,700 age- and gender-matched controls from a health maintenance organization completed surveys 12 months apart; 66.2% returned the first questionnaire. Rome III criteria identified 231 with FC and 201 with IBS-C. The second survey was completed by 195 of the FC and 141 of the IBS-C cohorts. Both surveys assessed the severity of constipation and IBS, quality of life (QOL), and psychological distress.

RESULTS:

(i) Overlap: if the Rome III requirement that patients meeting criteria for IBS cannot be diagnosed with FC is suspended, 89.5% of IBS-C cases meet criteria for FC and 43.8% of FC patients fulfill criteria for IBS-C. (ii) No qualitative differences between FC and IBS-C: 44.8% of FC patients report abdominal pain, and paradoxically IBS-C patients have more constipation symptoms than FC. (iii) Switching between diagnoses: by 12 months, 1/3 of FC transition to IBS-C and 1/3 of IBS-C change to FC.

CONCLUSIONS:

Patients identified by Rome III criteria for FC and IBS-C are not distinct groups. Revisions to the Rome III criteria, possibly including incorporation of physiological tests of transit and pelvic floor function, are needed.