Comparative Study Between Rome III and Rome Criteria in College Students With Functional Gastrointestinal Disorders / 胃肠病学

Background: The newly released Rome criteria in 2016 has a stricter and more precise definition of functional gastrointestinal disorders (FGIDs) when compared with Rome III criteria. The adjustment and improvement of diagnostic criteria by Rome criteria may affect the clinical diagnosis of FGIDs. Aims: To investigate the differences and the similarities between Rome III and Rome criteria in the diagnosis of FGIDs in college students. Methods: The FGIDs database of college students in Zhejiang Province established by our previous research team were further evaluated and analyzed by Rome criteria, and the incidence, psychological symptom score, overlapping of disease of FGIDs were calculated, and compared with Rome III criteria. Results: Of the 1 870 cases in database, 1 025 (54.81%) met Rome criteria of FGIDs; while 1 111 (59.41%) met Rome III criteria, the difference in detection rate was statistically significant (P <0.01). In Rome group, incidences of belching disorders (2.14% vs. 5.83%, P<0.01), irritable bowel syndrome (IBS) (2.78% vs. 6.90%, P<0.01), functional abdominal bloating/distension (1.28% vs. 4.12%, P<0.01) were significantly lower than those in Rome III group, while incidence of functional diarrhea was significantly higher (3.85% vs. 0.70%, P<0.01). Patients met Rome criteria showed a higher score of obsession⁃compulsion, depression and anxiety (P<0.05). Rome criteria caused 33 (25.58%) original IBS patients included in functional diarrhea, and 6 (4.65%) original IBS patients included in function constipation. The diagnosis of functional bowel disease overlapping with other FGIDs (belching disorders, functional dyspepsia) according to Rome III and Rome criteria were statistically different (P<0.01, P<0.05). Conclusions: Rome criteria has a stricter and more accurate definition of FGIDs, reflecting a more accurate psychological and clinical features, and identification of patients who really need treatment, resulting in a more efficient and feasible application in clinical practice and scientific research.

Prevalence of anti-tissue transglutaminase antibodies in patients with irritable bowel syndrome in Duhok city / Prevalência de anticorpos antitransglutaminase tecidual em pacientes com síndrome do intestino irritável na cidade de Duhok

Abstract Background Irritable bowel syndrome (IBS) is a common gastrointestinal disorder; celiac disease is an autoimmune enteropathy that can mimic any functional gastrointestinal disorder. The aim of this study is to estimate the prevalence of celiac disease antibodies (anti Tissue Transglutaminase-tTG) in patients with irritable bowel syndrome. Patients and methods This cross sectional study was conducted on 70 patients with irritable bowel syndrome fulfilling Rome III criteria who visited Azadi Teaching Hospital in Duhok city-Iraq. Patients were classified according to irritable bowel syndrome subtypes into: Diarrhoea Predominant (D-IBS), Constipation Predominant (C-IBS) and Mixed (M-IBS). IgA and IgG anti tTG were used to screen patients for celiac disease. Results A total number of 70 patients (44 females and 26 males) were included; their mean age was 33 years (SD ± 7.64). Five patients (7.1%) were found to have positive both IgA and IgG anti tTG. Three of them have had D-IBS and the other two had C-IBS. No one of the M-IBS patients tested positive. Conclusion The prevalence of anti tTG antibodies in irritable bowel syndrome is high. Patients with D-IBS should be screened for celiac disease.

Resumo Introdução A síndrome do intestino irritável (SII) é um distúrbio gastrointestinal comum; a doença celíaca é uma enteropatia autoimune que pode imitar qualquer distúrbio gastrointestinal funcional. O objetivo deste estudo foi estimar a prevalência de anticorpos contra a doença celíaca (antitransglutaminase tecidual - tTG) em pacientes com SII. Pacientes e Métodos Este estudo transversal foi conduzido em 70 pacientes com síndrome do intestino irritável que atendiam aos critérios de Roma III e se apresentaram ao Hospital de Ensino Azadi na cidade de Duhok, no Iraque. Os pacientes foram classificados de acordo com os subtipos de síndrome do intestino irritável em: predominantemente diarreia (D-SII), predominantemente constipação (C-SII) e mista (M-SII). IgA e IgG antitTG foram usados para rastrear pacientes com doença celíaca. Resultados Um total de 70 pacientes (44 mulheres e 26 homens) foram incluídos; a idade média foi de 33 anos (DP ± 7,64). Cinco pacientes (7,1%) apresentaram IgA e IgG antitTG positivos. Três deles tinham D-SII e os outros dois tinham C-SII. Nenhum dos pacientes com M-SII apresentou teste positivo. Conclusão A prevalência de anticorpos antitTG na SII é alta. A presença de doença celíaca deve ser avaliada em pacientes com D-SII.

Therapeutic Response for Functional Abdominal Pain in Children with Occult Constipation: Laxatives versus Prokinetic Drugs

The relationship between functional abdominal pain (FAP) and occult constipation (OC) in children who did not meet the Rome III criteria for constipation has rarely been reported. This study aimed to estimate the prevalence of OC in patients with FAP and to compare the effectiveness of prokinetic drugs and laxatives for FAP and OC. Pediatric outpatients (n = 212; aged 4–15 years) who satisfied the Rome III criteria for childhood FAP were divided into 2 groups based on Leech scores: group 1 < 8; group 2 ≥ 8. Group 2 received either prokinetic drugs or laxatives and pain severity was assessed after 2 weeks, 1 month, and 3 months. A total 52.4% (111/212) of patients had OC in this study. More patients who received laxatives had reduced pain scores compared with those who received prokinetic drugs. Those treated with laxatives in group 2 had a better response than those treated with prokinetic drugs throughout the study period (P < 0.001, P < 0.001, and P = 0.002 after 2 weeks, 1 month, and 3 months, respectively). OC was frequently encountered in children with FAP. Laxatives can be more effective than prokinetic drugs for relieving symptoms of FAP in children with a Leech score ≥ 8 and suspected OC.

Development, Translation and Validation of Enhanced Asian Rome III Questionnaires for Diagnosis of Functional Bowel Diseases in Major Asian Languages: A Rome Foundation-Asian Neurogastroenterology and Motility Association Working Team Report

BAome III criteria. METHODS: After EAR3Q was developed by Asian experts by cCKGROUND/AIMS: The development-processes by regional socio-cultural adaptation of an Enhanced Asian Rome III questionnaire (EAR3Q), a cultural adaptation of the Rome III diagnostic questionnaire (R3DQ), and its translation-validation in Asian languages are presented. As English is not the first language for most Asians, translation-validation of EAR3Q is essential. Hence, we aimed to culturally adapt the R3DQ to develop EAR3Q and linguistically validate it to show that the EAR3Q is able to allocate diagnosis according to Ronsensus, it was translated into Chinese, Hindi-Telugu, Indonesian, Korean, and Thai, following Rome Foundation guidelines; these were then validated on native subjects (healthy [n = 60], and patients with irritable bowel syndrome [n = 59], functional dyspepsia [n = 53] and functional constipation [n = 61]) diagnosed by clinicians using Rome III criteria, negative alarm features and investigations. RESULTS: Experts noted words for constipation, bloating, fullness and heartburn, posed difficulty. The English back-translated questionnaires demonstrated concordance with the original EAR3Q. Sensitivity and specificity of the questionnaires were high enough to diagnose respective functional gastrointestinal disorders (gold standard: clinical diagnoses) in most except Korean and Indonesian languages. Questionnaires often uncovered overlapping functional gastrointestinal disorders. Test-retest agreement (kappa) values of the translated questionnaires were high (0.700-1.000) except in Korean (0.300-0.500) and Indonesian (0.100-0.400) languages at the initial and 2-week follow-up visit. CONCLUSIONS: Though Chinese, Hindi and Telugu translations were performed well, Korean and Indonesian versions were not. Questionnaires often uncovered overlapping FGIDs, which were quite common.

Avaliação topográfica do cólon transverso pelo enema opaco: definição, prevalência e proposta de classificação da ptose do cólon transverso / Topographic evaluation of the transverse colon by barium enema: definition, prevalence and proposed of a classification of the enteroptosis

Objetivo: a ptose do cólon foi definida em 1922 por Cannon como rebaixamento do segmento transverso, em forma de V, podendo estender-se até o nível pélvico, sendo que quanto mais agudos forem os ângulos das flexuras esplênica e hepática, maior será a gravidade da sintomatologia, que inclui flatulência, distensão abdominal e constipação. Embora seja consenso na prática clínica que a enteroptose seja detectada frequentemente nos enemas opacos, ainda não há unanimidade na sua definição conceitual, além da inexistência de dados sobre sua prevalência. A possível relação entre esta alteração patológica e a constipação intestinal torna ainda mais relevante e instigante o seu estudo. Objetivo: definir e estabelecer a prevalência em nosso meio, e propor uma classificação radiológica para a enteroptose. Método: este estudo foi realizado em duas etapas. Na primeira foram analisados 193 enemas opacos digitais, visando estabelecer a prevalência da ptose. E a segunda propôs uma classificação topográfica em graus (0, 1 e 2), sendo a de Grau 2 considerada como a enteroptose verdadeira. Resultados: a prevalência de enteroptose verdadeira foi de 35 (18%) dos 193 enemas opacos examinados, sendo estatisticamente mais prevalente em mulheres (p=0,039). Considerando a prevalência mundial da constipação de até 20%, é plausível supor que possa haver correlação entre constipação e ptose Grau 2. Conclusão: não há na literatura mundial estudos sobre prevalência ou classificação da ptose do transverso, e acreditamos que a presente classificação em graus, associada à avaliação sintomatológica baseada nos critérios de Roma III, será um grande norteador para indicar a conduta diagnóstica na constipação.

Introduction: the enteroptosis was defined in 1922 by Cannon as flattening of the transverse segment, in V form, extending to the pelvic level, and if more acute are the angles of splenic and liver flexures, greater will be the symptom including flatulence, bloating and constipation. Although consensus in clinical practice often detected enteroptosis in barium enemas, there is no unanimity in the conceptual definition, besides there is no data about the prevalence. The possible relationship between this pathological change and constipation becomes this study even more relevant and compelling. Objective: define, establish the prevalence in our environment and propose a radiological classification for enteroptosis. Method: this study was conducted in two phases. In the first 193 digital barium enemas were analyzed to establish the prevalence of eneroptosis. The second proposed a topographic classification in degrees (0. 1 and 2), being considered Degree 2 as the true enteroptosis. Results: the prevalence of true enteroptosis was 35 (18 %) of the 193 examined barium enemas, being statistically more prevalent in women (p=0.039). Given the global prevalence of constipation up to 20% it is plausible that there may be a correlation between constipation and enteroptosis Degree 2. Conclusion: there are no studies in the literature about the prevalence or classification of enteroptosis, and we believe that the present classification in degrees, associated with the symptomatology assessment based in Rome III criteria will be a great guiding to indicate the diagnostic of constipation.

Constipation prevalence in diabetic patients / Frequência da constipação intestinal em pacientes diabéticos

OBJECTIVE: the aim of this study was to identify the prevalence of constipation in diabetic patients treated at the endocrinology outpatient clinic at Hospital Universitário Professor Alberto Antunes and PAM Salgadinho, from April to August 2013. METHODS: a descriptive and cross-sectional study, carried out through a questionnaire using the Rome III criteria in 372 patients treated at the outpatient endocrinology clinic. RESULTS: of 372 patients evaluated, the frequency of constipation found was 31.2% among diabetic patients. Females predominated in the sample (72.8%) as well as for the frequency of constipation (80.2%). The incidence of type II diabetes was 97.3% and it was observed that 80.2% of the sample was older than 50 years. One hundred and twelve patients with inadequate glycemic control (HgA1c = 7) had an association with constipation. CONCLUSION: there was an increased frequency of constipation in patients with diabetes mellitus according to the Rome III criteria, in relation to the general population. The inadequate glycemic control in patients with diabetes mellitus increases the frequency of constipation and it is necessary to perform studies that allow the confirmation of this association to demonstrate this hypothesis. (AU)

OBJETIVO: analisar a prevalência da constipação intestinal em pacientes diabéticos atendidos no ambulatório de endocrinologia do Hospital Universitário Professor Alberto Antunes e no PAM Salgadinho (HUPAA), de abril de 2013 a agosto 2013. MÉTODO: estudo descritivo e transversal, realizado através da aplicação de um questionário com os critérios de Roma III no ambulatório de endocrinologia do HUPAA. RESULTADO: em 372 pacientes, 271 feminino, 101 masculino, 162 de etnia branca, 55 negros e 155 pardos, 297 pacientes estavam acima de 50 anos, houve uma frequência de constipação de 31,2% nos pacientes diabéticos. O gênero feminino prevaleceu na amostra (73%) assim como no índice de frequência da constipação (80,2%). Em nossa amostra a diabetes Tipo II foi verificada em 360 pacientes (97%) e o tipo 1 em 12 pacientes (3%), observou-se que 80% da amostra apresentavam idade superior a 50 anos. Em 112 pacientes com controle glicêmico inadequado (HgA1c =7) havia uma associação com a constipação intestinal. CONCLUSÃO: encontramos maior frequência da constipação intestinal em pacientes com Diabetes Mellitus, segundo os critérios de Roma III, em relação à população geral. Há uma associação entre o controle glicêmico inadequado nos pacientes com Diabetes Mellitus e a frequência da constipação, faz-se necessário a realização de outros estudos que possibilitem confirmar a associação dessa varíavel para comprovação desta hipótese. (AU)

Efficacy and Safety of Tiropramide in the Treatment of Patients With Irritable Bowel Syndrome: A Multicenter, Randomized, Double-blind, Non-inferiority Trial, Compared With Octylonium

BACKGROUND/AIMS: Antispasmodics such as octylonium are widely used to manage irritable bowel syndrome (IBS) symptoms. However, the efficacy and safety of another antispasmodic, tiropramide, remain uncertain. We aimed to evaluate the efficacy and safety of tiropramide compared with octylonium in patients with IBS. METHODS: In this multicenter, randomized, non-inferiority trial, 287 patients with IBS (143 receiving tiropramide and 144 octylonium) were randomly allocated to either tiropramide 100 mg or octylonium 20 mg t.i.d (means 3 times a day) for 4 weeks. Primary endpoint was the mean change of abdominal pain from baseline assessed by visual analogue scales (VAS) score after 4 weeks of treatment. Secondary endpoints were the changes in abdominal pain from baseline at week 2 and in abdominal discomfort at weeks 2 and 4, using VAS scores, patient-reported symptom improvement including stool frequency and consistency, using symptom diaries, IBS-quality of life (IBS-QoL), and depression and anxiety, at week 4. RESULTS: The VAS scores of abdominal pain at week 4, were significantly decreased in both tiropramide and octylonium groups, but the change from baseline did not differ between the 2 groups (difference,-0.26 mm; 95% CI,-4.33-3.82; P = 0.901). Abdominal pain and discomfort assessed using VAS scores, diaries, and IBS-QoL were also improved by both treatments, and the changes from baseline did not differ. The incidence of adverse events was similar in the 2 groups, and no severe adverse events involving either drug were observed. CONCLUSIONS: Tiropramide is as effective as octylonium in managing abdominal pain in IBS, with a similar safety profile.

G Protein beta3 Subunit Polymorphism and Long-Term Prognosis of Functional Dyspepsia

BACKGROUND/AIMS: A link between G protein beta3 (GNB3) polymorphism and functional dyspepsia (FD) has been suggested. The aim of this study was to determine the role of GNB3 polymorphism in the long-term prognosis of FD in Koreans. METHODS: FD patients and normal healthy controls were recruited from patients who visited our center between December 2006 and June 2007. All of the subjects completed Rome III questionnaires before undergoing upper gastrointestinal endoscopy and colonoscopy. Genomic DNA was extracted for GNB3 genotyping. After 5 years, the subjects were reevaluated using the same questionnaires. RESULTS: GNB3 825T carrier status was significantly related to FD in Koreans (p=0.04). After 5 years, 61.0% of the initial FD patients and 12.2% of the initial normal subjects were diagnosed with FD (odds ratio [OR], 11.7; 95% confidence interval [CI], 4.3 to 31.1; p<0.001). Regardless of the GNB3 genotype (p=0.798), female sex was strongly correlated with FD after 5 years (OR, 3.3; 95% CI, 1.2 to 9.1; p=0.017). CONCLUSIONS: The T allele of GNB3 is linked to FD in Koreans but does not predict long-term prognosis. Female sex is related to a higher prevalence of FD after 5 years.

Prevalence, Clinical Characteristics, and Management of Functional Constipation at Pediatric Gastroenterology Clinics

The purpose of this study was to investigate the prevalence, clinical characteristics, and management of functional constipation at pediatric gastroenterology clinics. A prospective survey using the Rome III criteria was distributed to a group of parents of children with a constipation history and its control group in May 2008. The mean prevalence of constipation was 6.4%, which was similar to those in other countries. Statistically significant variables for children without constipation were that more children had a body mass index of below the 10th percentile even though they received more mother's care and ate balanced meals compared to the constipation group. Meanwhile, the constipation group frequently showed a history of constipation in infancy, picky-eating, lack of exercise, and retentive posturing. When analyzed with the Rome III criteria, the children showed greater than 60% rate of hard stools, painful stools, a history of large fecal mass in rectum, and its disappearance of constipation symptoms after passing a large stool. Our study found different approaches amongst pediatric gastroenterologists like rectal examinations, disimpaction, or drug treatment. Several factors addressed in our study can provide better guidelines for clinicians treating constipation and its future research.

Clinical and life style variables in functional dyspepsia and its sub-types.

Background: Several definitions and classifications have been designed to characterize functional dyspepsia (FD), the recent one being the ROME III criteria. There have been many studies in the western population which aimed at identifying the risk factors involved in functional dyspepsia. There are fewer studies from south Asian countries. Aim: To determine the clinical and life style variables influencing functional dyspepsia and its sub-types in patients attending a tertiary care referral centre in the Indian subcontinent. Methods: Consecutive patients with upper gastrointestinal symptoms including, epigastric pain/burning, early satiety, postprandial fullness, heartburn and/or chest discomfort, alone or in combination, on more than 3 occasions a week, within the preceding 6 months and with a normal endoscopy were included in the study. Demographic details and the symptom profile including frequency of symptoms were recorded in a pre-structured, validated, modified proforma as per the ROME III criteria and analyzed to test the study hypothesis. Results: Of the 170 patients, the median age of presentation was 49 yrs and the male to female ratio was 0.62 (65:105). The mean BMI was 23.8 kg/m2. Women had a higher BMI than men. More than half of the study subjects were from the low socio-economic groups.77.6% had ulcer type symptoms and showed a decreasing trend with age. It was more common in patients with higher per capita income. Reflux type comprised of 60.6% with predominance in women. 7% had early satiety and 13.5% had postprandial fullness. Nausea and belch as an isolated (associated) phenomenon comprised of 18.8% and 17.1% respectively. None of the lifestyle variables or demographic characteristics showed a significant influence on symptom occurrence. Conclusions: There was a considerable overlap of various sub-types of dyspepsia. There were no differences in life style characteristics or significant risk factors in the various subtypes of dyspepsia.

Gender Role in Irritable Bowel Syndrome: A Comparison of Irritable Bowel Syndrome Module (ROME III) Between Male and Female Patients

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a widespread chronic health condition which is significantly more prevalent in women. We conducted a gender difference analysis by comparing findings of men and women to determine whether any significant differences exist or not. METHODS: This single-center study was conducted in Tehran, Iran during 2009-2010. IBS was diagnosed on the basis of Rome III criteria. A simple "10 point" objective questionnaire was used. RESULTS: A total number of 144 IBS patients including 44 (30.6%) males and 100 (69.4%) females with the mean age of 37.50 +/- 11.50 years, were assessed. The only differently observed symptom was nausea which was significantly more prevalent in females (49% vs 18.2%, P < 0.001). The commonest subtype of IBS in male patients was diarrhea predominant IBS (38.6%); while, constipation predominant IBS was the most frequent type among females (38%). Moreover, the frequency of loose, mushy or watery stools within the last 3 months was significantly higher among males (2.11 +/- 1.67 vs 1.37 +/- 1.50, P = 0.009). CONCLUSIONS: We report that gender is important in IBS. Although qualitative comparison of different subtypes of IBS between male and female failed to meet the statistically significant level, the answers to the corresponding questions of ROME III IBS module suggest the higher prevalence of bowel movements and looser stool in males. Moreover, nausea was reported more often by females.

Disfunción del esfínter de Oddi y pancreatitis idiopática / Sphincter of Oddi dysfunction (SOD) and idiopatic pancreatitis

The sphincter of Oddi dysfunction is a little known entity that typically occurs in post-cholecystectomy patients with abdominal pain with biliary or pancreatic characteristics. It represents an important cause of idiopathic recurrent acute pancreatitis. Most of the patients referred for sphincter of Oddi dysfunction study have another disease which explain the symptoms, so a careful history and appropriate physical examination often can identify the true source of the pain. The most used grading score is the Milwaukee classification, based on clinical, laboratory, imaging and cholangiographic findings. In the last decade, new and more applicable criteria have been developed, such as Rome III criteria, which do not require functional tests considered complex and not available in non-specialized centers. The sphincter of Oddimanometry is considered the gold standard for the diagnosis of this entity, allowing for the determination of which patients will benefit from endoscopic therapy (sphincterotomy). There are some noninvasive diagnostic tests that have failed to show strong correlation to displace the sphincter of Oddi. The treatment of this condition is mainly based on endoscopic sphincterotomy, with variable success rates depending on the type of dysfunction. This article presents a review of the most important aspects related to the sphincter of Oddi and its relationship with idiopathic recurrent pancreatitis.

La disfunción del esfínter de Oddi es una entidad poco conocida, que típicamente se presenta en pacientes post-colecistectomía con dolor abdominal de tipo “biliar” o “pancreático”. Representa unaimportante causa de pancreatitis aguda recurrente idiopática. La mayoría de los pacientes derivados para estudio de disfunción del esfínter de Oddi corresponden a otra causa o enfermedad que explica los síntomas, por lo que una cuidadosa historia clínica y un adecuado examen físico, a menudo permiten identificar el verdadero origen del cuadro doloroso. La clasificación más utilizada es la de Milwaukee basada en parámetros clínicos, de laboratorio, imagenológicos y colangiográficos. En la última década, se han elaborado criterios de mayor aplicabilidad clínica como los criterios de Roma III, que no requieren de test funcionales considerados complejos y poco disponibles en centros no especializados. La manometría del esfínter de Oddi es considerado el gold standard en el diagnóstico de esta entidad, permitiendo además, establecer quiénes se beneficiarán con la terapia endoscópica (esfinterotomía). Se han desarrollado una serie de otros métodos diagnósticos no invasivos, que no han logrado demostrar una correlación suficientemente sólida para desplazar a la manometría. El tratamiento de esta condición se basa principalmente en la esfinterotomía endoscópica, con una tasa de éxito variable dependiendo del tipo de disfunción. En el presente artículo se revisarán los aspectos más importantes relacionados con la disfunción del esfínter de Oddi y su relación con pancreatitis recurrente idiopática.

Functional Abdominal Pain in Children / 대한소아소화기영양학회지

Functional abdominal pain (FAP) is one of the most common pain syndromes in childhood and is a functional gastrointestinal disorder (FGID). Recurrent abdominal pain (RAP) is characterized by three or more episodes of abdominal pain that occurover at least 3 months and are severe enough to interfere with activities. It may be caused by many conditions, including inflammatory bowel disease, peptic ulcer, pancreatitis or, functional abdominal pain. The most common clinical manifestation is periumbilical pain related to autonomic and functional symptoms like nausea, vomiting, pallor and other painful conditions like headache and limb pains. RAP requires accurate diagnostic tests to rule out organic causes of pain based on 'red flag' sign. Furthermore, to diagnose and classify functional abdominal pain, Rome III criteria were published and updated with multiple discussions of FGIDs. Conventional interventions for RAP include reassurance and general advice, symptom-based pharmacological therapies, and psychological and behavioral treatments. But further research should be conducted to advance our understanding of the multiple factors involved in the pathogenesis of this group of conditions and to provide evidence for its therapeutic benefit.

Sensibilidad visceral y dispepsia funcional: o ¿mucho más que eso? / Visceral sensitivity and functional dyspepsia: or much more than this?

La sensibilidad visceral es una respuesta fisiológica normal de las estructuras huecas del tracto alimentario y su alteración (híper o hiposensibilidad) se ha involucrado en la génesis de la mayoría de los trastornos funcionales y su corrección o modulación fundamentan la mayoría de los esfuerzos actuales farmacológicos que buscan la supresión o alivio de síntomas asociados a estas alteraciones. La dispepsia funcional es un trastorno mal entendido fisiopatológicamente, lleno aún de equívocos diagnósticos y sujeto permanente de cambios en su definición, clasificación y enfoque terapéutico.Dada la prevalencia de la entidad parece útil revisar la conceptualización actual de la dispepsia y el papel de la sensibilidad visceral, como el elemento disparador fisiológico de la motilidad, en su fisiopatología.

Visceral sensitivity is a normal physiological response of digestive tract hollow structures. Hypersensitivity and hypo sensitivity have been involved in the genesis of most functional disorders. Currently correction or modulation is usually based on pharmacological efforts which seek to eliminate or alleviate symptoms associated with these disorders. Functional dyspepsia is a poorly understood physiopathological disorder still associated with diagnostic misunderstandings and permanently changing definition, classification and therapeutic approaches. Given the prevalence of this entity it seems useful to review the current conceptualization of dyspepsia and the role of visceral sensitivity as the physiological timer of motility in its physiopathology.

The Differences in Prevalence and Sociodemographic Characteristics of Irritable Bowel Syndrome According to Rome II and Rome III

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is one of the most frequently observed disorders by primary care and practitioners. The aim of this study was to estimate the prevalence of IBS using the Rome II and III criteria in the general Korean population and also to compare sociodemographic differences between subjects diagnosed by these criteria. METHODS: Telephone interview surveys were performed with a total of 1,009 individuals in Korea, 15 years of age or older. The questionnaire, based on the Rome II and III criteria, was validated. RESULTS: Among the 1,009 subjects, the prevalence of IBS was 8.0% under the Rome II criteria (81 subjects; 6.4%, male; 9.6%, female), and 9.0% (91 subjects; 7.0%, male; 11.0%, female) under the Rome III criteria. The accordance rate of Rome II and III was 73.5%. Both groups showed highest frequency in the age of 30s (13.9% vs. 15.3% respectively). Female subjects showed a higher prevalence than male subjects under Rome III (91 subjects; 11.0% in female, 7.0% in male; p < 0.05), but not under Rome II criteria. Many patients older than 50 years were added when analyzed under the Rome III criteria, but not under the Rome II criteria (p = 0.017). CONCLUSIONS: The Rome III criteria were less restrictive and showed good agreement with the Rome II criteria. The prevalence of IBS was increased in young women.

Prevalencia del síndrome de intestino irritable y la relación del estrés laboral con esta patología en los médicos especialistas de dos centros hospitalarios y uno imagenologico de Maracay edo Aragua. Venezuela 2008

El síndrome de intestino irritable (SII) es una entidad clínica crónica, recurrente y común, de difícil diagnóstico, siendo la base diagnóstica la evaluación sintomática. Se ha descrito el estrés emocional como un factor desencadenante de los síntomas que la identifican, pudiéndose presentar con una alta prevalencia en la población joven y laboralmente activa. Objetivos: Determinar la prevalencia del SII, según los Criterios de Roma III, en una población de médicos de tres centros hospitalarios de Maracay. Mayo 2008 y evidenciar la relación del estrés laboral con esta patología. Métodos: A una muestra de 83 médicos especialistas de consultas, aparentemente sanos, del HCM, ASODIAM y HS, escogidos al azar, se les aplicó una encuesta-cuestionario, previo consentimiento verbal individual, interrogando los criterios de Roma III y la Escala de Maslach para medir el estrés laboral. Resultados: Según Roma III la prevalencia del SII en médicos especialistas fue de 37,3% (77,5% femeninos y 22,5% masculinos), de los cuales el 67,7% presentaron estrés laboral. Conclusión: Según el diagnóstico por criterios de Roma III existe una alta prevalencia de SII en la población de médicos especialistas, donde se describe al estrés como posible factor desencadenante de hechos fisiopatológicos que provocan la sintomatología de este síndrome en el grupo estudiado.

Irritable bowel syndrome (IBS) is a clinical chronic entity, recurrent and common; the diagnosis is based on symptomatic diagnostic evaluation. Emotional stress has been described as a trigger for the symptoms; it can be presented with a high prevalence in young population and labor force. Objectives: To determine the prevalence of IBS according to Rome III Criteria in a population of three doctors of hospitals in Maracay, May 2008 and to demonstrate the relationship of work stress with this condition. Methods: A sample of 83 specialists for consultations, apparently healthy of the HCM, and ASODIAM HS, chosen randomly, were interviewed with a questionnaire survey, previous individual verbal consent, using the Rome III Criteria and the Scale of Maslach to measure work stress. Results: According to the Rome III Criteria, the prevalence of IBS in medical specialists was 37.3% (77.5% female and 22.5% male), of which 67.7% had work-related stress. Conclusion: Accordingwith the Rome III Criteria there is a high prevalence of IBS in the physiciansÊ population, which describes stress as a possible trigger for pathophysiological events that cause the symptoms of this syndrome in this study.

Constipation and functional faecal retention in a group of school children in a district in Sri Lanka.

Objective To assess the prevalence of constipation and functional faecal retention among a group of school children in Gampaha district of Sri Lanka. Method This is a cross sectional survey. A validated, self-administered questionnaire was distributed to randomly selected children, aged 10- 16 years, in a semi-urban school in Gampaha District of Sri Lanka. Constipation was defined using Rome III criteria and Paris Consensus on Childhood Constipation Terminology (PACCT). Functional faecal retention was diagnosed using Rome II criteria. Results A total of 441 questionnaires were distributed and 429 (97.3%) responded (53.1% males, mean age 12.4 years, SD 1.5 years). According to Rome III criteria and PACCT, 46 (10.7%) had constipation. Prevalence of constipation was higher in males (14.5%) compared to females (6.5%) [OR 2.45, 95% CI 1.19-5.1, p=0.012]. Twenty three (5.4%) had functional faecal retention. Conclusions Chronic constipation is a significant problem, affecting approximately 10% of children in a semi-urban school in Gampaha district. It is commoner among males. Both Rome III criteria and PACCT are effective in diagnosing childhood constipation in epidemiological studies.

Chronic Abdominal Pain-related Childhood Functional Gastrointestinal Disorders Based on the Rome III Criteria in Korea / 대한소아소화기영양학회지

PURPOSE: Chronic abdominal pain is a common complaint encountered in pediatric clinics. This study aimed to investigate chronic functional abdominal pain in Korean children and adolescents by applying the Rome III criteria. METHODS: A prospective study on chronic abdominal pain in 194 patients was conducted between July 2006 and August 2007. The parents of the subjects were asked to respond to a questionnaire based on the Rome III criteria. These responses were evaluated by pediatricians, and subsequently, the patients were clinically evaluated. RESULTS: On the basis of the results of the medical evaluation, 167 of the 194 patients (86.1%) were diagnosed with functional gastrointestinal disorders, i.e., no organic causes of chronic abdominal pain were detected during the medical evaluation. Of these 167 patients, 89.8% of the patients satisfied one of the Rome III criteria, while 10.2% of the patients did not satisfy any of the Rome III criteria for chronic abdominal pain-related functional gastrointestinal disorders (functional dyspepsia, 29.3%; irritable bowel syndrome, 25.7%; abdominal migraine, 7.8%; childhood functional abdominal pain, 27.0%; and childhood functional abdominal pain syndrome, 12.6%). Compared to other symptom subtypes, children with childhood functional abdominal pain experienced an earlier onset and a shorter duration of symptoms. CONCLUSION: The Rome III criteria are more comprehensive; the use of these criteria will provide more accurate information and better diagnoses for children and adolescents with chronic abdominal pain.

Diagnosis of Functional Gastrointestinal Disorders with Rome III Criteria in Korean Pediatric and Adolescent Patients: Clinical Usefulness of QPGS / 대한소아소화기영양학회지

PURPOSE: We diagnosed pediatric functional gastrointestinal disorders in Korean children and adolescents using Rome III criteria and investigated the clinical validity of QPGS-Rome III. METHODS: Diagnosis based on QPGS was compared with the physician's diagnosis based on Rome III criteria. One hundred and thirty eight children and their parents completed the QPGS. Agreement rates were measured using Kappa method. RESULTS: In physician's diagnoses, the most prevalent disorders were functional dyspepsia (39.1%), irritable bowel syndrome (38.4%), and functional abdominal pain (18.8%). Among QPGS based diagnoses, the most prevalent disorders were irritable bowel syndrome (39.1%), functional dyspepsia (29.7%), and functional abdominal pain (21.7%). The agreement rate was substantial (kappa=0.72, p=0.00). Diagnostic disagreements probably resulted from different patient responses to bowel movement form and bowel frequency. CONCLUSION: Functional dyspepsia, irritable bowel syndrome, and functional abdominal pain were the most common disorders by Rome III criteria in the Korean pediatric and adolescent patients. The agreement rate between physician's diagnoses and QPGS based diagnoses supported the validity of the QPGS-Rome III in Korean pediatric and adolescent patients. QPGS seems to be useful in diagnosis of patients with functional gastrointestinal disorders by Rome III criteria.