Observational Study
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World J Gastroenterol. Nov 21, 2014; 20(43): 16293-16299
Published online Nov 21, 2014. doi: 10.3748/wjg.v20.i43.16293
Functional gastrointestinal disorders in eating disorder patients: Altered distribution and predictors using ROME III compared to ROME II criteria
Xiaojie Wang, Georgina M Luscombe, Catherine Boyd, John Kellow, Suzanne Abraham
Xiaojie Wang, Catherine Boyd, Department of Obstetrics and Gynaecology, University of Sydney, NSW 2006, Australia
Georgina M Luscombe, School of Rural Health, University of Sydney, Orange, NSW 2800, Australia
John Kellow, Department of Gastroenterology and Medicine, University of Sydney, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
Suzanne Abraham, Department of Obstetrics and Gynaecology, Northside Clinic, University of Sydney, Royal North Shore Hospital, NSW 2065, Australia
Author contributions: Wang X and Abraham S contributed to the design of the study; Boyd C perfomed the clinical research on the ROME II data; Wang X performed the clinical research on ROME III, data analyses and wrote the first draft; Luscombe GM contributed in statistical analyses; Wang X, Abraham S, Kellow J and Luscombe GM contributed to the interpretation of data, critical review of the article, and approved the final manuscript.
Correspondence to: Suzanne Abraham, Associate Professor, Department of Obstetrics and Gynaecology, University of Sydney, Building 52, Royal North Shore Hospital, St Leonards, NSW 2065, Australia. suzanne.abraham@sydney.edu.au
Telephone: +61-2-94629802 Fax: +61-2-94629802
Received: April 4, 2014
Revised: May 20, 2014
Accepted: June 21, 2014
Published online: November 21, 2014
Processing time: 230 Days and 7.6 Hours
Abstract

AIM: To compare the prevalence of Functional gastrointestinal disorders (FGIDs) using ROME III and ROME II and to describe predictors of FGIDs among eating disorder (ED) patients.

METHODS: Two similar cohorts of female ED inpatients, aged 17-50 years, with no organic gastrointestinal or systemic disorders, completed either the ROME III (n = 100) or the ROME II (n = 160) questionnaire on admission for ED treatment. The two ROME cohorts were compared on continuous demographic variables (e.g., age, BMI) using Student’s t-tests, and on categorical variables (e.g., ED diagnosis) using χ2-tests. The relationship between ED diagnostic subtypes and FGID categories was explored using χ2-tests. Age, BMI, and psychological and behavioural predictors of the common (prevalence greater than 20%) ROME III FGIDs were tested using logistic regression analyses.

RESULTS: The criteria for at least one FGID were fulfilled by 83% of the ROME III cohort, and 94% of the ROME II cohort. There were no significant differences in age, BMI, lowest ever BMI, ED diagnostic subtypes or ED-related quality of life (QOL) scores between ROME II and ROME III cohorts. The most prevalent FGIDs using ROME III were postprandial distress syndrome (PDS) (45%) and irritable bowel syndrome (IBS) (41%), followed by unspecified functional bowel disorders (U-FBD) (24%), and functional heartburn (FH) (22%). There was a 29% or 46% increase (depending on presence or absence of cyclic vomiting) in functional gastroduodenal disorders because of the introduction of PDS in ROME III compared to ROME II. There was a 35% decrease in functional bowel disorders (FBD) in Rome III (excluding U-FBD) compared to ROME II. The most significant predictor of PDS was starvation (P = 0.008). The predictor of FH (P = 0.021) and U-FBD (P = 0.007) was somatisation, and of IBS laxative use (P = 0.025). Age and BMI were not significant predictors. The addition of the 6-mo duration of symptoms requirement for a diagnosis in ROME III added precision to many FGIDs.

CONCLUSION: ROME III confers higher precision in diagnosing FGIDs but self-induced vomiting should be excluded from the diagnosis of cyclic vomiting. Psychological factors appear to be more influential in ROME II than ROME III.

Keywords: Anorexia nervosa; Bulimia nervosa; Eating disorders; Gastrointestinal diseases; Irritable bowel syndrome

Core tip: We compared the prevalence, behavioural and psychological predictors of functional gastrointestinal disorders using ROME III and ROME II questionnaires in two similar cohorts of eating disorder patients. We found the added timeframe requirement in ROME III added precision in diagnosing many Functional gastrointestinal disorders (FGIDs). We also found certain FGIDs in ROME III are predicted by eating behaviours and appear to have less psychological input compared to ROME II. These findings suggest that abnormal eating behaviours may play a more direct role in the disturbed physiology (both sensation and motility) of the gastrointestinal tract and hence the pathogenesis of certain FGIDs.