UEG's educational platform for gastroenterology education bringing recordings, courses, guidelines, and more together in one place.

UEG Week Berlin 2025 Recordings Gut Guide online

Rate for better recommendations!

Your feedback helps us show you more of what you like and less of what you dislike!

More of this!

We will show you more similar content.

Not for me!

We won't suggest this again.

Bookmark!

Save this content for later!

New to myUEG? Create an account! Log In with myUEG account

UEG Poster

Standard Poster

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

MODIFICATIONS OF ROME IV DIAGNOSTIC CRITERIA BASED ON DEFECATION SYMPTOM SPECTRUM IN CHINESE

Qing Huang 1, Yurong Huang 2, Siran Zhu 3, Yuen Tian 3, Tao Bai 3, Xiaohua Hou 3, Jie Yang 2

Affiliations

1 Chongqing Medical University, Chongqing, China

2 The Affiliated Hospital of Guizhou Medical University, Guiyang, China

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

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

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

Previous studies have demonstrated that the Chinese population has a more stringent interpretation of “normal” defecation. The symptom spectrum of Chinese constipated patients remains unknown.

Aims & Methods

To systematically investigate the symptom spectrum of Chinese constipated patients, and to evaluate the clinical applicability of Rome IV criteria in this distinct population.

Non-selective outpatients (aged ≥16 years) self-identified with “constipation” were enrolled and given the Rome IV questionnaire. Data on demographics, defecation frequency, stool forms, defecation symptoms, and abdominal symptoms were collected. Non-constipated controls were recruited from outpatients’ family members for demographics and defecation pattern data. Descriptive analysis was performed to contrast distribution differences between constipated and normal individuals, and to determine the abnormal defecation symptom thresholds. The consistency of Rome IV criteria with respondents’ self-assessments was evaluated, and modifications of Rome IV criteria were proposed based on these thresholds.

Results

The study enrolled 6364 constipated individuals and 1432 normal controls. In constipated individuals, the prevalent symptoms included straining (97.29%), sensation of incomplete evacuation (96.07%), hard stools (95.21%), sensation of anorectal obstruction (93.22%), reduced defecation frequency (91.67%), bloating or abdominal distension (87.13%), abdominal pain (76.71%), laxative-assisted defecation (23.98%), and manipulation-assisted defecation (21.51%).
Descriptive analysis has substantiated that constipated patients exhibit inter-individual symptom heterogeneity, validating the clinical utility of Rome IV's symptom cluster-based diagnostic paradigm. However, Rome IV criteria manifested poor consistency with self-assessment (Kappa=0.24, P<0.01), with high specificity (98.81%) but low sensitivity (47.30%). This discrepancy reflects stricter perceptions of normal defecation among the Chinese.
As for normal controls, the mean defecation frequency was 7.09±2.03/week, with the 90th percentile cutoff (4/week) stricter than Rome IV's 3/week benchmark. This quantitative analysis yielded six constipation diagnostic thresholds: defecation frequency = 4 times a week, hard stools =30%, straining =30%, sensation of incomplete evacuation =20%, sensation of anorectal obstruction or blockage =10%, and manipulation-assisted defecation =10%.
We compared five diagnostic approaches to determine the optimal symptom count for constipation diagnosis. As illustrated in the Table, the diagnostic approach with the presence of ≥2 abnormal symptoms had an excellent consistency (Kappa value =0.80, P < 0.01), high specificity (95.46%), and high sensitivity (92.94%).

Diagnostic Approach	Kappa Value	Specificity/%	Sensitivity/%
Rome IV Criteria	0.24	98.81	47.30
Two-Symptom Criteria	0.80	95.46	92.94
Three-Symptom Criteria	0.66	98.60	84.43
Four-Symptom Criteria	0.50	99.72	73.29
Five-Symptom Criteria	0.32	99.93	56.46
Six-Symptom Criteria	0.01	100.00	2.44

Conclusion

Rome IV criteria demonstrate suboptimal performance in consistency and sensitivity, mainly attributable to the stricter threshold for defecation frequency in China. After modifications, the novel dual-symptom diagnostic framework significantly improves consistency and sensitivity, offering a more tailored approach for diagnosing constipation in Chinese population. These findings underscore the necessity for region-specific adaptations of Rome IV criteria across diverse populations.

References

1. Chu H, Hou X. Understanding of constipation symptoms and the diagnosis and management of constipation in Chinese physicians. PLoS One. 2016 Mar 31;11(3):e0152801. https://pubmed.ncbi.nlm.nih.gov/27031865/
2. Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller R. Bowel disorders. Gastroenterology. 2016 Feb 18;150(6):1393-1407. https://pubmed.ncbi.nlm.nih.gov/27144627/
3. Zhu SR, Tian Y, Bai T, Hou XH. The defecation habits of people in Central China: a cross-sectional survey and a literature review. Neurogastroenterol Motil. 2020 Mar;32(S1):274. https://webofscience.clarivate.cn/wos/woscc/full-record/WOS:000521974900269

Conference

UEG Week Berlin 2025

Topics

Colorectal

Submission format

Abstract

Session

Constipation and defaecatory disorders (Posters)

Citation

United European Gastroenterology Journal 2025; 13 (Supplement 8)

Published

2025

More Like This:

How to handle high risk conditions for gastric cancer

Judith Honing

LINKING INCREASED COLONIC PERMEABILITY WITH AN ALTERED BLOOD-BRAIN BARRIER AND PRESENCE OF NEUROINFLAMMATION IN A RAT MODEL FOR DISORDERS OF GUT-BRAIN INTERACTION

Ricard Farré

MRI / SMARIA SHOWS POOR SENSITIVITY FOR DETECTING MUCOSAL INFLAMMATION AND ULCERATION EVIDENT ON COLONOSCOPY / SES-CD IN THE PROFILE TRIAL

Edmund Godfrey

MODIFICATIONS OF ROME IV DIAGNOSTIC CRITERIA BASED ON DEFECATION SYMPTOM SPECTRUM IN CHINESE

Jie Yang

The bum: Haemorrhoids, fissure disease, urgency and incontinence

Tatenda Marunda

Malabsorption in a patient with systemic sclerosis

Lucas Wauters

UEG's educational platform for gastroenterology education bringing recordings, courses, guidelines, and more together in one place.

Most popular content

Rate for better recommendations!

Redefining EoE Control: Elevating Patient Lives Beyond Symptom Suppression (Sanofi Regeneron) (Complete Session)

How to handle high risk conditions for gastric cancer

LINKING INCREASED COLONIC PERMEABILITY WITH AN ALTERED BLOOD-BRAIN BARRIER AND PRESENCE OF NEUROINFLAMMATION IN A RAT MODEL FOR DISORDERS OF GUT-BRAIN INTERACTION

MRI / SMARIA SHOWS POOR SENSITIVITY FOR DETECTING MUCOSAL INFLAMMATION AND ULCERATION EVIDENT ON COLONOSCOPY / SES-CD IN THE PROFILE TRIAL

MODIFICATIONS OF ROME IV DIAGNOSTIC CRITERIA BASED ON DEFECATION SYMPTOM SPECTRUM IN CHINESE

The bum: Haemorrhoids, fissure disease, urgency and incontinence

Malabsorption in a patient with systemic sclerosis