Inability of the Rome III Criteria to Distinguish Functional Constipation From Constipation-Subtype Irritable Bowel Syndrome
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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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- Authors
- Wong, R. K., Palsson, O. S., Turner, M. J., Levy, R. L., Feld, A. D., von Korff, M., & Whitehead, W. E.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- University of Washington (US)
- Group Health Cooperative (US)
- Corresponding author
- Whitehead, William E
- Venue
- American Journal of Gastroenterology
- Published
- 2010-10
- Volume
- 105
- Issue
- 10
- Pages
- 2228-2234
- ISSN
- 0002-9270 (ISSN-L)
- PMC
- PMC3786710
- OpenAlex
- W2051262240
- Cited by
- 204
- References
- 17
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 5 · 2023: 3 · 2022: 11 · 2021: 14 · 2020: 20 · 2019: 14 · 2018: 13 · 2017: 15 · 2016: 20 · 2015: 16 · 2014: 20 · 2013: 13 · 2012: 11
- FWCI
- 11.85
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- The American Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK031369, R24DK067674)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Surgery › Congenital gastrointestinal and neural anomalies
- Keywords
- functional constipation, irritable bowel syndrome with constipation, Rome III criteria, diagnostic classification, diagnostic overlap, disease transition, quality of life, psychological distress, abdominal pain, primary care
- MeSH terms
- Adult, Aged, Constipation, Diagnosis, Differential, Female, Humans, Male, Middle Aged, Prospective Studies, Quality of Life, Surveys and Questionnaires, Patient Selection, Statistics, Nonparametric, Irritable Bowel Syndrome
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