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EFFECTS OF CHANGES IN THE DIAGNOSTIC CRITERIA FOR IRRITABLE BOWEL SYNDROME (IBS) ON GLOBAL PREVALENCE RATES - RESULTS FROM THE ROME FOUNDATION GLOBAL EPIDEMIOLOGY STUDY

Navkiran Tornkvist 1, Olafur S. Palsson 2, Jóhann Hreinsson 1, Hans Törnblom 1, Brooks D. Cash 3, Maura Corsetti 4, Xiaohua Hou 5, Brian Lacy 6, Anthony J. Lembo 7, Max Julio Schmulson Wasserman 8, Andrea Shin 9, Shrikant Bangdiwala 10, Ami D. Sperber 11, Magnus Simrén 1,2

Affiliations

1 Institute of Medicine, Sahlgrenska University hospital, Gothenburg, Sweden

2 University of North Carolina, Chapel Hill, Chapel Hill, NC, United States

3 University of Texas Health Science Center, McGovern Medical School, Houston, TX, United States

4 University of Nottingham, Nottingham, United Kingdom

5 Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

6 Mayo Clinic Hospital, Ponte Vedra Beach, United States

7 Beth Israel Deaconess Medical Center, Boston, United States

8 Universidad Nacional Autónoma de México, Mexico City, Mexico

9 Indiana University, Indianapolis, United States

10 McMaster University, Hamilton, Canada

11 Ben-Gurion University of the Negev, Farod, Israel

Summary

AI Generated

Analysis of 54,127 individuals from 26 countries demonstrates that IBS prevalence changes substantially with minor modifications to diagnostic criteria, with the abdominal pain frequency threshold having the most prominent effect on prevalence rates.

IBS prevalence was 4.1% using Rome IV criteria and 10.1% using Rome III criteria in the Rome Foundation Global Epidemiology Study internet survey.
Lowering the abdominal pain frequency threshold from once per week to 2-3 days per month approximately doubled IBS prevalence rates across different diagnostic definitions.
Removing the required temporal association between abdominal pain and changes in bowel habits did not influence prevalence rates.
All IBS definitions evaluated showed female predominance, reduced quality of life, moderate symptom severity, and increased healthcare utilization compared with the general population.
The findings are intended to inform development of Rome V criteria for IBS.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

IBS prevalence is substantially lower with the current Rome IV criteria than with previous iterations. Previous analyses have suggested that this is primarily explained by the raising of the abdominal pain frequency threshold, followed by removal of the term discomfort from the definition.

Aims & Methods

We aimed to further explore how diagnostic criteria changes influence the prevalence of IBS and associated factors. Subjects from 26 countries who completed the internet survey in the Rome Foundation Global Epidemiology Study (RFGES) ¹were included.^.We used responses to Rome IV (all 26 countries) and Rome III (14 countries) diagnostic questions, the IBS Symptom Severity Scale (IBS-SSS), quality of life (PROMIS-10 QoL), and health care utilization (“ever consulted a doctor about a bowel problem”). Different definitions of IBS diagnostic criteria were applied: adding discomfort to the definition; changing the frequency threshold of abdominal pain and/or discomfort; removing the requirement that abdominal pain and/or discomfort and changes in bowel habits should be associated in time; and using bloating / abdominal distension as a proxy for discomfort.

Results

A total of 54,127 individuals completed the RFGES Internet survey (49.1% females; mean age 44.3 years, range 18-97 years). Of these, 29,609 completed both the Rome IV and Rome III questionnaires. The prevalence of IBS according to the Rome IV criteria was 4.1%, and 10.1% with Rome III criteria. Lowering the frequency threshold for abdominal pain and/or discomfort from ≥once per week to ≥2-3 days a month, approximately doubled the prevalence rates for the different definitions of IBS. Using the Rome III symptom definition of IBS (abdominal pain and/or discomfort) but retaining the Rome IV frequency threshold (≥once a week) yielded a similar prevalence rate (4.2%) as the Rome IV IBS definition. Removing the required association in time between abdominal pain and/or discomfort and changes in bowel habits did not influence the prevalence rates (Table 1). For all the definitions evaluated there was a female predominance, a reduction in QoL and increases in health care utilization compared with the general global population, and on average moderate IBS symptom severity (Table 1).

Table 1. IBS prevalence, female/male ratio, quality of life, IBS symptom severity and health care utilization with different IBS definitions.

	Total global sample	IBS 1 Rome IV Abd. Pain≥1 day/week associated with defecation and/or change in bowel habits)	IBS 2 Modified Rome IV Abd. Pain≥2-3 days/month associated with defecation and/or change in bowel habits)	IBS 3 No time association between pain and abnormal bowel habits (Abd. Pain≥1 day/week + abnormal bowel habits)	IBS 4 Modified, no time association requirement between pain and abnormal bowel habits (Abd. Pain≥2-3 days/month + abnormal bowel habits)	IBS 5 Bloating – IBS Abdominal bloating and/or distension (proxy of discomfort) (≥1 day/week) + abnormal bowel habits)	IBS 6 Modified Bloating – IBS Abdominal bloating and/or distension (proxy of discomfort) (≥2-3 days/month) + abnormal bowel habits)	IBS 7 Rome III Abd. pain and/or discomfort ≥2-3 days/month associated with pain/discomfort relief with defecation and/or change in bowel habits	IBS 8 Modified Rome III Abd pain and/or discomfort ≥1 day/week associated with pain/discomfort relief with defecation and/or change in bowel habits
Prevalence (%)	NA	4.1	8.0	4.2	8.3	6.1	13.3	10.1	4.2
Proportion (%) who also meets IBS Rome IV	NA	100	50.4	82.7	42.3	40.6	19.9	26.8	46.3
Female/male ratio	NA	1.8	1.7	1.9	1.9	2.2	2.0	1.6	1.7
Mental QoL^#	13.6	11.2	11.6	11.1	11.5	11.4	11.9	11.5	11.0
Physical QoL^#	14.5	11.8	12.4	11.8	12.3	12.2	12.8	12.4	11.8
IBS severity^¤	NA	248	219	246	217	239	197	191	236
Health care use for bowel problems (%)^*	33	69	63	68	62	63	56	64	69

# PROMIS-10 QoL score
¤IBS-SSS (IBS Symptom Severity Score)
*Ever consulted a doctor about a bowel problem

Conclusion

The global prevalence of IBS changes substantially with relatively minor changes in the symptom-based IBS definitions. Specifically, changing the abdominal pain and/or discomfort frequency threshold seems to have the most prominent effect on IBS prevalence. Even with more relaxed IBS definitions, a substantial impact on QoL and health care utilization is still evident. This information will be useful when defining the Rome V criteria for IBS.
Acknowledgment: The study was conducted under the auspices of the Rome Foundation Research Institute.

References

¹Sperber et al Gastroenterology 2021

Conference

UEG Week Copenhagen 2023

Topics

Colorectal

Submission format

Abstract

Session

All about disorders of gut-brain interaction (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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