Influence of Rome IV diagnostic criteria on patients with irritable bowel syndrome

Objective To investigate the improvement of symptoms of the patients after treatment in patients with Rome Ⅳ or non-Rome Ⅳ irritable bowel syndrome (IBS), and to explore the influence of IBS diagnosed by different criteria on the patients. Methods From June 2nd to 8th in 2016, at Outpatients Department of Gastroenterology, Union Hospital Affiliated to Tongji Medical College, Huazhong Uiversity of Science and Technology in Wuhan, 1 500 outpatients aged over 18 years old and with intestinal symptom were selected for questionnaire. After treatment for six months, IBS patients, non-IBS patients, patients with Rome Ⅳ IBS and patients with non-Rome Ⅳ IBS were followed up by phone calls. After treatment, the improvement of symptoms of the patients was evaluated by irritable bowel syndrome symptom severity scale (IBS-SSS). The degree of influence of IBS diagnosed with different criteria on patients was evaluated by the patient′s daily work whether to choose colonoscopy examination, whether to choose medication, and the efficacy of medicine. Student′s t test, Mann-Whitney U test and chi-square test were performed for statistical analysis. Results A total of 352 patients with intestinal symptoms were followed-up, including 175 patients with IBS (84 patients with Rome Ⅳ IBS and 91 patients with non-Rome Ⅳ IBS) and 177 non-IBS patients, and 142 patients responded. There were no statistically significant differences in response rate between non-IBS patients and IBS patients (37.3%, 66/177 vs. 43.4%, 76/175), and between patients with Rome Ⅳ IBS and patients with non-Rome Ⅳ IBS (40.5%, 34/84 vs. 46.2%, 42/91) (χ2=1.379 and 0.573, P=0.240 and 0.449). Compared with the non-IBS patients, the degree of satisfaction of medicine was lower in IBS patients (71.4%, 30/42 vs. 47.5%, 19/40). Compared with non-Rome Ⅳ IBS patients, Rome type Ⅳ IBS patients were more likely to receive colonoscopy (35.7%, 15/42 vs. 58.8%, 20/34), and the differences were statistically significant (χ2=4.878 and 4.039, P=0.027 and 0.044). After six months of treatment, symptoms improved in both Rome Ⅳ IBS patients and non-Rome Ⅳ IBS patients (both P<0.05), however, the symptoms improved more significantly in Rome Ⅳ IBS patients and the total score of IBS-SSS was lower than that of non-Rome Ⅳ IBS patients (-130, -185 to 60 vs. -70, -100 to 28), and the difference was statistically significant (Z=-3.065, P=0.002). The difference was mainly showed the symptom of abdominal pain, and the IBS-SSS abdominal pain score of Rome Ⅳ IBS patients was lower than that of non-Rome Ⅳ IBS patients (-80, -100 to -40 vs. 0, -40 to 0), and the difference was statistically significant (Z=-4.631, P<0.01). Conclusions IBS symptoms influence a lot on the satisfaction degree of treatment in outpatients. Even with similar good therapeutic effects, the Rome Ⅳ IBS symptoms have a more severe impact on patients than non-Rome Ⅳ IBS symptoms. Key words: Irritable bowel syndrome; Diagnosis; Rome type Ⅳ; Treatment response