The epidemiology and quality of life of functional gastrointestinal disorders according to Rome III vs Rome IV criteria: A cross-sectional study in primary care

Epidemiology of Disorders of the Gut-Brain Interaction: An Appraisal of the Rome IV Criteria and Beyond

Disorders of the gut-brain interaction (DGBIs) are presently classified into mutually exclusive anatomical area-related symptom-based categories according to the Rome IV criteria. The pathophysiology of visceral nociception, which contributes to the wide range of symptoms of DGBIs, involves complex psychobiological processes arising from the bidirectional interactions of multiple systems at the gut and brain levels, which affect symptom expression and illness behaviors. The attitude toward an illness and expression of pain and bowel habit vary across cultures with variable interpretation based on sociocultural beliefs, which may not tally with the medical definitions. Thus, psychological factors impact DGBI definitions, their severity and health care utilization. Due to the poor localization and multisegment referral of visceral pain, the anatomical site of pain may not correspond to the affected segment, and there may be a variable degree of overlap among symptoms. The somewhat restrictively defined Rome IV criteria assume one-to-one correlation of symptoms with underlying pathophysiology and ignore overlapping DGBIs, nonstandardized symptom categories, and change or shift in category over time. The microorganic nature of DGBIs resulting from systemic, metabolic or motility disorders, gut dysbiosis and inflammation are not addressed in the Rome IV criteria. Although there is a multidimensional clinical profile that does address these factors, it is not followed rigorously in practice. Threshold changes for diagnostic criteria or addition/deletion of symptoms leads to wide variation among different DGBI criteria resulting in uncertain comparability of results. Although the Rome IV criteria are excellent for research studies and therapeutic trials in homogenous populations, further improvement is needed for their wider applicability in clinical practice.

Treating disorders of brain-gut interaction with multidisciplinary integrated care. Moving towards a new standard of care

Disorders of brain-gut interaction (DGBI) are highly prevalent in our community with a negative burden on the quality of life and function. Symptoms are frequently food-induced, and psychological disorders are commonly co-morbid and contribute greatly to symptom severity and healthcare utilization, which can complicate management. Pathophysiological contributors to the development and maintenance of DGBI are best appreciated within the biopsychosocial model of illness. Established treatments include medical therapies targeting gastrointestinal physiology, luminal microbiota or visceral sensitivity, dietary treatments including dietary optimization and specific therapeutic diets such as a low-FODMAP diet, and psychological interventions. The traditional "medical model" of care, driven predominantly by doctors, poorly serves sufferers of DBGI, with research indicating that a multidisciplinary, integrated-care approach produces better outcomes. This narrative review explores the current evidence for multidisciplinary care and provides the best practice recommendations for physicians and healthcare systems managing such patients.

Global prevalence of functional dyspepsia according to Rome criteria, 1990-2020: a systematic review and meta-analysis

Although functional dyspepsia (FD) is a common functional gastroduodenal disorder with a high socioeconomic burden, little is known about its global prevalence. Thus, we performed a comprehensive study to estimate long-term trends in the prevalence of FD. We searched PubMed/MEDLINE, Embase, and Google Scholar from 1990 to 2022 for population-based studies that reported the prevalence of FD in adults (≥ 18 years old) according to Rome I, II, III, or IV criteria. The prevalence of FD was extracted from included studies to obtain pooled prevalence with 95% confidence intervals (CI) and 95% prediction intervals. Subgroup analysis was performed according to certain characteristics, including geographic region. A total of 44 studies met the eligibility criteria, including 256,915 participants from 40 countries across six continents. The overall global pooled prevalence of FD was 8.4% (95% CI 7.4-.9.5). The prevalence was the highest in Rome I (11.9%; 95% CI 5.1-25.4) and lowest in Rome IV (6.8%; 95% CI 5.8-7.9). Developing countries showed a higher prevalence than developed countries (9.1% versus 8.0%), and prevalence was higher in women, irrespective of the definition used (9.0% versus 7.0%). The pooled prevalence gradually decreased from 1990 to 2020 (12.4% [8.2-18.3] in 1990-2002 versus 7.3% [6.1-8.7] in 2013-2020). The prevalence of FD differs by country, economic status, geographical region, and sex, and the global prevalence has been gradually declining. Despite the heterogeneity of sample population, our study estimates the current global burden of FD and provides information to heath care policy decisions.

Clinical outcome of disorders of gut-brain interaction in secondary care: A longitudinal study

BACKGROUND

Real-world data on the outcome of routine treatment for disorders of gut-brain interaction (DGBI) in secondary care are lacking.

METHOD

A longitudinal study of consecutive adult patients with various DGBI attending this institution's gastroenterology clinic was conducted. Following 2 years of treatment, the proportion of patients with symptom improvement, details of clinical therapy, factors associated with and the impact of 'no symptom improvement' were determined.

RESULTS

A total of 289 patients (median age 68 years; 64.7% females; 28.4% irritable bowel syndrome (IBS), 20.1% functional dyspepsia (FD), 8.7% functional constipation (FC), 42.9% overlap syndrome) were recruited. After 2 years, 66.1% patients reported symptom improvement. Patients with overlap syndrome were less likely to have symptomatic improvement compared to those with a single DGBI (Overlap 55.6% vs IBS 74.4% vs FD 72.4% vs FC 76.0%, p = 0.014). Reassurance was associated with symptom improvement (p < 0.001). On multivariate analysis, overlap syndrome remained significantly associated with a poorer outcome (OR 2.27, 95% CI 1.22-4.25, p = 0.010), while providing reassurance was associated with a positive outcome (OR 0.30, 95% CI 0.16-0.56, p < 0.001). Only 25.6% and 14.9% of patients were referred for a low FODMAP diet and psychiatric intervention respectively. DGBI patients who had 'no improvement' were more likely to seek further GI consultations and had more work absenteeism.

CONCLUSION

Two-thirds of DGBI patients in secondary care showed symptom improvement. Patients who were reassured had better symptom improvement, while those with an overlap syndrome were associated with a poorer outcome, resulting in greater healthcare consultation and work absenteeism.

Gastrointestinal Dysfunction in Parkinson's Disease: Neuro-Gastroenterology Perspectives on a Multifaceted Problem

Patients with Parkinson's disease (PD) face a multitude of gastrointestinal (GI) symptoms, including nausea, bloating, reduced bowel movements, and difficulties with defecation. These symptoms are common and may accumulate during the course of PD but are often under-recognized and challenging to manage. Objective testing can be burdensome to patients and does not correlate well with symptoms. Effective treatment options are limited. Evidence is often based on studies in the general population, and specific evidence in PD is scarce. Upper GI dysfunction may also interfere with the pharmacological treatment of PD motor symptoms, which poses significant management challenges. Several new less invasive assessment tools and novel treatment options have emerged in recent years. The current review provides an overview and a practical approach to recognizing and diagnosing common upper and lower GI problems in PD, e.g., dyspepsia, gastroparesis, small bowel dysfunction, chronic constipation, and defecatory dysfunction. Management aspects are discussed based on the latest evidence from the PD and general populations, with insights for future research pertaining to GI dysfunction in PD.

Indian consensus statements on irritable bowel syndrome in adults: A guideline by the Indian Neurogastroenterology and Motility Association and jointly supported by the Indian Society of Gastroenterology

The Indian Neurogastroenterology and Motility Association (INMA), earlier named the Indian Motility and Functional Diseases Association developed this evidence-based practice guidelines for the management of irritable bowel syndrome (IBS). A modified Delphi process was used to develop this consensus containing 28 statements, which were concerning diagnostic criteria, epidemiology, etiopathogenesis and comorbidities, investigations, lifestyle modifications and treatments. Owing to the Coronavirus disease-19 (COVID-19) pandemic, lockdowns and mobility restrictions, web-based meetings and electronic voting were the major tools used to develop this consensus. A statement was regarded as accepted when the sum of "completely accepted" and "accepted with minor reservation" voted responses were 80% or higher. Finally, the consensus was achieved on all 28 statements. The consensus team members are of the view that this work may find use in teaching, patient care, and research on IBS in India and other nations.

Functional gastrointestinal disorders among healthcare professionals at a tertiary Australian hospital

Background and Aim

The aim of this study was to determine the frequency, characteristics, and associations of functional gastrointestinal disorders (FGIDs) among healthcare professionals.

Methods

A qualitative survey was conducted among the staff at a tertiary Australian hospital between January 2017 and June 2018. Rome III criteria (excluding endoscopic) were used to define FGID. Multivariable logistic regression was used to explore associations.

Results

Of the 274 respondents (17% doctors, 66% nurses, 17% others; 77% female), 54% had experienced GI symptoms ≥3 times per week and 23% were diagnosed with FGIDs (2% IBS, 19% FD, 2% both). GI symptoms were more common in females (58% vs. 38%), Caucasians versus Asians (59% vs. 35%), respondents who were easily (67% vs. 40%) or often stressed (58% vs. 37%), and had irregular working hours (62% vs. 46%, each P < 0.05). Independent predictors of GI symptoms included being easily stressed (OR 2.7) and female sex (OR 2.4), while Asian ethnicity was protective (OR 0.42, each P < 0.05). FGIDs were more prevalent in respondents who often felt stressed (27% vs. 10%), felt easily stressed (29% vs. 17%), and in nurses compared to others (27% vs. 16%; each P < 0.05). The only independent predictor of FGID was being often stressed (OR 4.1, P = 0.011).

Conclusions

FGIDs and GI symptoms are prevalent among hospital workers. Stress, female sex, irregular working hours, and non-Asian ethnicity appeared to be associated with GI symptoms and FGIDs.

Functional Abdominal Cramping Pain: Expert Practical Guidance

Functional abdominal cramping pain (FACP) is a common complaint, which may present either on its own or in association with a functional gastrointestinal disorder. It is likely caused by a variety of, probably partly unknown, etiologies. Effective management of FACP can be challenging owing to the lack of usable diagnostic tools and the availability of a diverse range of treatment approaches. Practical guidance for their selection and use is limited. The objective of this article is to present a working definition of FACP based on expert consensus, and to propose practical strategies for the diagnosis and management of this condition for physicians, pharmacists, and patients. A panel of experts on functional gastrointestinal disorders was convened to participate in workshop activities aimed at defining FACP and agreeing upon a recommended sequence of diagnostic criteria and management recommendations. The key principles forming the foundation of the definition of FACP and suggested management algorithms include the primacy of cramping pain as the distinguishing symptom; the importance of recognizing and acting upon alarm signals of potential structural disease; the recognition of known causes that might be addressed through lifestyle adjustment; and the central role of antispasmodics in the treatment of FACP. The proposed algorithm is intended to assist physicians in reaching a meaningful diagnostic endpoint based on patient-reported symptoms of FACP. We also discuss how this algorithm may be adapted for use by pharmacists and patients.

Epidemiological trends of gastrointestinal and liver diseases in Malaysia: A single-center observational study

BACKGROUND AND AIM

The spectrum of gastrointestinal (GI) and liver diseases is recognized to have a geographical variation, which may be due to environmental or genetic differences. We aimed to explore this further in a specialist clinic serving a multi-ethnic Asian urban population.

METHODS

A retrospective analysis of outpatient data from this institution's electronic medical records was conducted between January and June 2019. Clinical diagnoses of GI and liver diseases and associated demographic information were collected.

RESULTS

Data from 3676 adult patients (median age 62 years, female 51.1%) were available for analysis. The frequency of luminal GI, liver and pancreato-biliary diseases were 34.2%, 63.2%, and 2.6%, respectively. Among luminal GI diseases, 38.6% were functional gastrointestinal disorders and 61.4% had an organic cause. A higher proportion of patients of Indian ethnicity were diagnosed with IBD compared with other ethnic groups (India 21.9%, Malay 16.5%, Chinese 12.2%, P = 0.001). Among liver diseases, the most common etiologies were HBV (44.4%) and NAFLD (39.3%). Cirrhosis and/or hepatocellular carcinoma were present in 18% of liver diseases, with NAFLD as the most frequent etiology. Among patients with NAFLD, a higher proportion of ethnic Malays and Indians were evident (Malay 53.8% vs Chinese 28.7% vs Indian 61.1%, P < 0.001). In contrast, a greater proportion of ethnic Chinese were diagnosed with HBV compared with other ethnic groups (Malay 30.9% vs Chinese 57.5% vs Indian 8.4%, P < 0.001).

CONCLUSION

The spectrum of GI and liver diseases has a peculiar epidemiology, particularly with reference to the ethnic predilection of certain diseases.

Epidemiology of functional gastrointestinal disorders using ROME III adult questionnaire, a population based cross sectional study in Karachi-Pakistan

Objective

Functional Gastrointestinal Disorder (FGIDs) are a heterogenous group of disorders, with Irritable Bowel Syndrome (IBS) and Functional Dyspepsia (FD) being the most common disorders worldwide. The purpose of this study was to identify the spectra of FGIDs classified according to the ROME III criteria amongst an adult Pakistani population. It also aimed to correlate the psychosocial alarm symptoms with the prevalence of FGIDs and report the overlap of all FGID.

Design

This was a community based cross-sectional study. Multi-stage cluster sampling technique was applied, and 1062 households were initially randomly chosen using systematic sampling technique. Only one person from each household was enrolled in the study. After eligibility screening, 860 participating individuals were requested to fill out a structured ROME III interview questionnaire, administered to them by a trained interviewer.

Results

FGIDs were diagnosed in 468 individuals (54.4%), out of 860 participants. FD was found to be the most prevalent (70.2%), followed by Functional Heartburn (58.9%) and Functional bloating (56.6%). Amongst a total of 468 participants diagnosed with FGIDs, 347 (74.1%) had overlapping disorders. There was also a higher incidence of psychosocial alarm symptoms including higher pain severity (62.6% vs 46.4%) and being victimized at some point in their lives (26.1% vs 6.6%) amongst FGID patients.

Conclusion

There is a high disease burden of FGIDs in this study population, with approximately half of the population suffering from at least one type of FGID. Overlapping disorders are also common in this part of the world.

Functional dyspepsia leads to more healthcare utilization in secondary care compared with other functional gastrointestinal disorders

OBJECTIVE

Functional gastrointestinal disorders (FGIDs) are known to have a significant impact on patients' quality of life and lead to a greater healthcare burden. In this study we aimed to investigate whether this healthcare burden differs among various types of FGIDs in secondary care.

METHODS

A retrospective study of consecutive adults with luminal gastrointestinal (GI) diseases in a secondary healthcare gastroenterology clinic was conducted. The frequency of FGIDs and differences in healthcare utilization among different types of FGIDs were explored.

RESULTS

Among 1206 patients with luminal GI disease, 442 (36.7%) had FGIDs. FGIDs patients were older (67 y vs 62 y, P < 0.001) with a higher proportion of women (61.8% vs 50.4%, P < 0.001) than those without FGIDs. Functional dyspepsia (FD) was the most common FGIDs (36.9%), followed by irritable bowel syndrome (IBS) (30.3%). A high healthcare burden (defined as over one GI endoscopy or imaging examination over 5 years, or  one or more unscheduled visit to general practitioner or emergency department or hospitalization annually) was observed among 53.8% of the FGIDs patients. FD was associated with a high healthcare burden (high vs low burden: 43.7% vs 28.9%, P = 0.001) while IBS was associated with lower healthcare burden (high vs low burden: 25.2% vs 36.3%, P = 0.012). On multivariate analysis, only FD was significantly associated with high healthcare burden (adjusted odds ratio 1.996, 95% confidence interval 1.117-3.567, P = 0.020).

CONCLUSION

Compared with other FGIDs, FD was the most common condition in secondary care, and it was associated with the greatest healthcare burden.

Prevalence, clinical characteristics, and management of irritable bowel syndrome in Vietnam: A scoping review

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders worldwide. Its prevalence varies significantly from country to country, largely due to heterogeneity in the available data. Recent studies show that the prevalence of IBS in Asia is on the rise. However, there are very limited data regarding its prevalence in the Vietnamese population. This review aims to offer an overview of the prevalence and clinical characteristics of IBS in the Vietnamese population; and to discuss the current management of IBS in Vietnam-taking into account the available medical resources and the local spectrum of lower gastrointestinal disorders that may mimic IBS.

Overlap of functional dyspepsia and irritable bowel syndrome by revised Rome IV criteria: meta-analysis

Introduction. Functional dyspepsia (FD) and irritable bowel syndrome (IBS) overlap is an adverse clinical situation, as patients with this syndrome have more severe clinical manifestations resulting in significant reductions in quality of life. For now, there are no meta-analytical papers that would summarize the frequency of FD – IBS overlap using the revised Rome IV criteria. Objective. To organize data on the prevalence of FD – IBS overlap using the revised Rome IV criteria.

Materials and methods. A search for studies was conducted in MEDLINE / PubMed, EMBASE, Cochrane electronic databases. The search depth was 6 years (from January 2016 to February 2021). The final analysis included original publications from peerreviewed periodicals that used the revised Rome IV criteria as a method for diagnosing FD and IBS in the adult population with detailed descriptive statistics allowing to include resulting data in the meta-analysis.

Results and discussion. The final analysis included 6 studies involving 1,180 patients with PD and 600 patients with IBS. The generalized prevalence of IBS in patients with PD was 41.511% (95% CI: 22.203–62.288). The analysis was undertaken by using a random-effects model, as there was significant heterogeneity among results (p < 0.0001; I2 = 94.28%). The generalized prevalence of PD in patients with IBS was 38.791% (95% CI: 9.438–73.710). The analysis was undertaken by using a random-effects model, as there was significant heterogeneity among results (p < 0.0001; I2 = 99.25%).

Сonclusion. The complete meta-analysis showed that the frequency of FD - IBS overlap using the revised Rome IV criteria is quite high and accounts for about 40%. At the same time, further large studies of more homogeneous structure are needed to verify these results and study the potential pathogenetic relationship between PD and IBS.