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. 2010 Oct;105(10):2228-34.
doi: 10.1038/ajg.2010.200. Epub 2010 May 25.

Inability of the Rome III criteria to distinguish functional constipation from constipation-subtype irritable bowel syndrome

Reuben K Wong  1 , Olafur S Palsson, Marsha J Turner, Rona L Levy, Andrew D Feld, Michael von Korff, William E Whitehead
Affiliations

Inability of the Rome III criteria to distinguish functional constipation from constipation-subtype irritable bowel syndrome

Reuben K Wong et al. Am J Gastroenterol. 2010 Oct.

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.

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Conflict of interest statement

Potential competing interests:

William E. Whitehead has served on the board of the Rome Foundation since 1990. He has also served on advisory boards for Novartis Pharmaceuticals, Takeda Pharmaceuticals, and Ironwoods, each of which has developed and/or marketed drugs for the treatment of functional constipation and irritable bowel syndrome with constipation. He has been the recipient of research grants from Novartis and Takeda pharmaceutical companies. None of the other authors have competing interests.

Figures

Figure 1
Figure 1
Study enrollment and follow-up flow chart.
Figure 2
Figure 2
Venn diagram showing overlap between IBS-C and FC when the Rome III requirement that FC cannot be diagnosed in a patient who meets criteria for IBS is suspended.
See this image and copyright information in PMC

Comment in

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