Natural History and Disease Impact of Rome IV versus Rome III Irritable Bowel Syndrome: A Longitudinal Follow-up Study.

Abstract

OBJECTIVES\nIrritable bowel syndrome (IBS) is a chronic functional bowel disorder diagnosed using the Rome criteria, which have evolved since their original description 30 years ago. Little is known about the effects on the natural history of IBS of moving to the latest iteration, Rome IV, from the previous Rome III criteria. We conducted a 12-month longitudinal follow-up study examining this.\n\n\nMETHODS\nWe collected complete demographic, symptom, mood, and psychological health data at baseline from 1097 adults who self-identified as having IBS and met either Rome IV or III criteria. At 12 months, we collected data regarding IBS symptom severity and impact, consultation behavior, treatments commenced, and psychological health. We examined whether subsequent disease behavior in Rome IV or Rome III-defined IBS differed.\n\n\nRESULTS\nAt 12 months, 638 (58.2%) of the 1097 participants were successfully followed up. Of these, 452 met Rome IV criteria and 186 met Rome III criteria at baseline. During the 12-month study period, individuals with Rome IV IBS were significantly more likely to have seen a primary care physician (44.7% vs 28.5%, p<0.001) or a gastroenterologist (26.3% vs 12.4%, p<0.001) for their IBS symptoms, were significantly more likely to have commenced a new treatment (73.0% vs 60.2%, p=0.001), and cycled through significantly more treatments (p=0.007), for their IBS compared with those with Rome III IBS. At follow-up, individuals with Rome IV IBS had more severe symptoms, which had a significantly greater impact on activities of daily living, were more likely to report continuous abdominal pain, and a higher proportion demonstrated poor psychological health, compared with those with Rome III IBS (p<0.001 for all analyses).\n\n\nCONCLUSIONS\nThe natural history of IBS defined according to Rome IV criteria is more severe than that of Rome III-defined IBS. This has important implications for future treatment trials in IBS.