Rome Foundation Global Epidemiology Study The Rome Foundation
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| # | First Author Full Name | Article Title | Year Published | Full Citation | Link to Article | Full Abstract | Study Aims [Lay Language] | Conclusion |
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| 1 | Ami D Sperber | Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study | 2021 | Sperber, A. D., S. I. Bangdiwala, D. A. Drossman, U. C. Ghoshal, M. Simren, J. Tack, W. E. Whitehead, D. L. Dumitrascu, X. Fang, S. Fukudo, J. Kellow, E. Okeke, E. M. M. Quigley, M. Schmulson, P. Whorwell, T. Archampong, P. Adibi, V. Andresen, M. A. Benninga, B. Bonaz, S. Bor, L. B. Fernandez, S. C. Choi, E. S. Corazziari, C. Francisconi, A. Hani, L. Lazebnik, Y. Y. Lee, A. Mulak, M. M. Rahman, J. Santos, M. Setshedi, A. F. Syam, S. Vanner, R. K. Wong, A. Lopez-Colombo, V. Costa, R. Dickman, M. Kanazawa, A. H. Keshteli, R. Khatun, I. Maleki, P. Poitras, N. Pratap, O. Stefanyuk, S. Thomson, J. Zeevenhooven and O. S. Palsson (2021). "Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study." Gastroenterology 160(1): 99-114 e113. | https://www.ncbi.nlm.nih.gov/pubmed/32294476 | BACKGROUND & AIMS: Although functional gastrointestinal disorders (FGIDs), now called disorders of gut-brain interaction, have major economic effects on health care systems and adversely affect quality of life, little is known about their global prevalence and distribution. We investigated the prevalence of and factors associated with 22 FGIDs, in 33 countries on 6continents. METHODS: Data were collected via the Internet in 24 countries, personal interviews in 7 countries, and both in 2 countries, using the Rome IV diagnostic questionnaire, Rome III irritable bowel syndrome questions, and 80 items to identify variables associated with FGIDs. Data collection methods differed for Internet and household groups, so data analyseswere conducted and reported separately. RESULTS: Among the 73,076 adult respondents (49.5% women), diagnostic criteria were met for at least 1 FGID by 40.3% persons who completed the Internet surveys (95% confidence interval [CI],39.9–40.7) and 20.7% of persons who completed the household surveys (95% CI, 20.2–21.3). FGIDs were more prevalent among women than men, based on responses to the Internet survey (odds ratio, 1.7; 95% CI, 1.6–1.7) and household survey (odds ratio, 1.3; 95% CI, 1.3–1.4). FGIDs were associated with lower quality of life and more frequent doctor visits. Proportions of subjects with irritable bowel syndrome were lower when the Rome IV criteria were used, compared with the Rome III criteria, in the Internet survey (4.1% vs 10.1%) and household survey (1.5% vs 3.5%). CONCLUSIONS: In a large-scale multinational study, we found that more than 40% of persons worldwide have FGIDs, which affect quality of life and health care use. Although the absolute prevalence was higher among Internet respondents, similar trends and relative distributions were found in people who completed Internet vs personal interviews | We investigated the prevalence of and factors associated with 22 DGBI in 33 countries on 6 continents | In a large-scale multinational study, we found that more than 40% of persons worldwide have FGIDs, which affect quality of life and health care use. Although the absolute prevalence was higher among Internet respondents, similar trends and relative distributions were found in people who completed Internet vs personal interviews |
| 2 | Ami D Sperber | Greater Overlap of Rome IV Disorders of Gut-Brain Interactions Leads to Increased Disease Severity and Poorer Quality of Life | 2022 | Sperber, A. D., T. Freud, I. Aziz, O. S. Palsson, D. A. Drossman, D. L. Dumitrascu, X. Fang, S. Fukudo, U. C. Ghoshal, J. Kellow, R. Khatun, E. Okeke, E. M. M. Quigley, M. Schmulson, M. Simren, J. Tack, W. E. Whitehead, P. Whorwell and S. I. Bangdiwala (2022). "Greater Overlap of Rome IV Disorders of Gut-Brain Interactions Leads to Increased Disease Severity and Poorer Quality of Life." Clin Gastroenterol Hepatol 20(5): e945-e956. | https://www.ncbi.nlm.nih.gov/pubmed/34052391 | Conditions such as irritable bowel syndrome (IBS), functional dyspepsia, and functional constipation are among the prevalent gastrointestinal (GI) disorders classified as disorders of gutbrain interaction (DGBI), which can adversely affect the lives of sufferers. This study aimed to assess the degree and consequences of overlapping DGBI in a large population-based global scale. METHODS: Internet survey data from 54,127 adults (49.1% women) in 26 countries were analyzed by 4 GI anatomic regions (esophageal, gastroduodenal, bowel, and anorectal). The number of DGBI affected GI regions was assessed, including associations with sex, age, disease severity, quality of life, psychosocial variables, and health care utilization. RESULTS: A total of 40.3% of surveyed individuals met Rome IV criteria for a DGBI. The percentages with 1–4 DGBI-affected GI regions were 68.3%, 22.3%, 7.1%, and 2.3%, respectively. The IBS symptom severity score increased significantly from 1 (207.6) to 4 (291.6) regions, as did non- GI symptom reporting (somatization), anxiety and depression, concerns and embarrassment about bowel function, doctor visits, medications, and abdominal surgeries (all P < .0001). Quality of life decreased with increasing number of DGBI regions (P < .0001). In a logistic mixed model, non-GI symptoms (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.08–1.10), being very vs not concerned (OR, 2.55; 95% CI, 2.27–2.90), being very vs not embarrassed about bowel function (OR, 1.20; 95% CI, 1.08–1.33), and mean number of doctor visits (OR, 1.23; 95% CI, 1.115–1.32) were most strongly associated with number of DGBI regions. CONCLUSIONS: DGBI in multiple anatomic GI regions is associated with increased psychological comorbidity, health care utilization, and IBS severity. Physician awareness of overlap could improve quality of care, prevent unnecessary interventions, and yield more positive health outcomes. | We assessed the degree and consequences of having multiple, overlapping DGBI | DGBI in multiple anatomic GI regions is associated with increased psychological comorbidity, health care utilization, and IBS severity. Physician awareness of overlap could improve quality of care, prevent unnecessary interventions, and yield more positive health outcomes. |
| 3 | Axel Josefsson | Global Prevalence and Impact of Rumination Syndrome | 2022 | Josefsson, A., J. P. Hreinsson, M. Simren, J. Tack, S. I. Bangdiwala, A. D. Sperber, O. S. Palsson and H. Tornblom (2022). "Global Prevalence and Impact of Rumination Syndrome." Gastroenterology 162(3): 731-742 e739. | https://www.ncbi.nlm.nih.gov/pubmed/34774539 | BACKGROUND & AIMS: Rumination syndrome is a Disorder of Gut-Brain Interaction (DGBI) of unknown etiology. We aimed to assess its global prevalence and potential associations with other medical conditions. METHODS: Data were collected via the Internet in 26 countries. Subjects were evenly distributed by country, sex, and age groups and were invited for a "health survey" using the Rome IV diagnostic questionnaire and a supplementary questionnaire addressing factors potentially associated with DGBI. RESULTS: In all, 54,127 subjects completed the survey (51% male; mean age, 44.3 years). The overall prevalence of rumination syndrome was 3.1% (95% confidence interval [CI], 3.0–3.3%). It was highest in Brazil (5.5% CI, 4.5–6.5) and lowest in Singapore (1.7% CI, 1.1–2.2). The mean age of people with rumination syndrome was 44.5 years (standard deviation, 15.6) and it was more common in females (54.5% vs 45.5%). Factors independently associated with rumination syndrome were depression (odds ratio [OR], 1.46), anxiety (OR, 1.8), body mass index (OR, 1.04), and female sex (OR, 1.19). Subjects with multiple DGBI were at increased risk of having rumination syndrome, with the highest risk in subjects with 4 gastrointestinal regions with DGBI (OR, 15.9 compared with none). Quality of life (QoL) was lower in subjects with rumination syndrome compared with the rest of the cohort (PROMIS-10 score: physical QoL mean 12.9 vs 14.5; | We aimed to assess the global prevalence of rumination syndrome and its potential associations with other medical conditions. | In conclusion, the findings of this survey of 26 nations demonstrate that the global prevalence of rumination syndrome is 3.1%, which is higher than reported in most previous population-based studies. Rumination syndrome is associated with higher BMI, female sex, psychological distress, somatization, reduced QoL, and higher health care use. It is likely underdiagnosed and awareness of it should be raised among clinicians. By being aware of the factors identified in this study, clinicians could identify subjects at risk and start appropriate therapy early. |
| 4 | Ami D. Sperber | Epidemiology of disorders of Gut-Brain interaction in Israel: Results from the Rome Foundation global epidemiology study | 2021 | Sperber, A. D. (2021). "Epidemiology and Burden of Irritable Bowel Syndrome: An International Perspective." Gastroenterol Clin North Am 50(3): 489-503. | https://www.ncbi.nlm.nih.gov/pubmed/34304784 | Background: Data for Israel from the Rome Foundation Global Epidemiology Study on the disorders of gut-brain interaction (DGBI) were used to assess the national prevalence of all 22 DGBI, the percentage of respondents meeting diagnostic criteria for at least one DGBI, and the impact on burden of disease in Israel. Methods: The survey was conducted through the Internet with multiple built-in quality-assurance techniques and included the Rome IV diagnostic questionnaire and an in-depth supplemental questionnaire. Key Results: 2012 Israeli participants completed the survey nationwide: mean age 44.6 ± 16.4 years, 50% females. The national distribution was very close to the latest Israeli census. 36.4% (95% CI 34.3, 38.4) met diagnostic criteria for at least one DGBI, with 4.4% for any esophageal disorder, 6.5% for any gastroduodenal disorder, 30.8% for any bowel disorder, and 5.3% for any anorectal disorder. The rates were higher for women. Having any DGBI was associated negatively with psychosocial variables (including quality of life, somatization, and concern about digestive problems), and healthcare utilization (including doctor visits, use of medications, and abdominal surgeries). Conclusions & Inferences: The results of this study provide the first in-depth assessment of the prevalence and burden of Rome IV DGBI in Israel and facilitate comparisons with other countries. As 36.4% of the 2,012 participants met diagnostic criteria for at least one DGBI, and 23.5% of those met criteria for more than one DGBI, the burden of DGBI in Israel is high, indicating a need to focus on research and training for patient care. | We assessed the prevalence and burden of Rome IV DGBI in Israel, compared to other countries. | The results of this study provide the first in-depth assessment of the prevalence and burden of Rome IV DGBI in Israel and facilitate comparisons with other countries. As 36.4% of the 2,012 participants met diagnostic criteria for at least one DGBI, and 23.5% of those met criteria for more than one DGBI, the burden of DGBI in Israel is high, indicating a need to focus on research and training for patient care. |
| 5 | Esther Colomier | Global prevalence and burden of mealrelated abdominal pain | 2022 | Colomier, E., C. Melchior, J. P. Algera, J. P. Hreinsson, S. Storsrud, H. Tornblom, L. Van Oudenhove, O. S. Palsson, S. I. Bangdiwala, A. D. Sperber, J. Tack and M. Simren (2022). "Global prevalence and burden of meal-related abdominal pain." BMC Med 20(1): 71. | https://www.ncbi.nlm.nih.gov/pubmed/35172840 | Background: Patients with disorders of gut-brain interaction (DGBI) report meal intake to be associated with symptoms. DGBI patients with meal-related symptoms may have more severe symptoms overall and worse health outcomes, but this subgroup has not been well characterized. We aimed to describe the global prevalence of mealrelated abdominal pain and characterize this subgroup. Methods: The data analyzed originated from the Internet survey component of the population-based Rome Foundation Global Epidemiology Study, completed in 26 countries (n = 54,127). Adult subjects were asked whether they had abdominal pain and how often this was meal-related. Respondents were categorized into "no," "occasional," and "frequent" meal-related abdominal pain groups based on 0%, 10–40%, and ≥50% of the pain episodes being meal-related, respectively. DGBI diagnoses, frequency of other GI symptoms, psychological distress, non-GI somatic symptoms, quality of life, and healthcare utilization were compared between groups. Mixed linear and ordinal regression was used to assess independent associations between psychological distress, non-GI somatic symptoms, quality of life, other GI symptoms, and meal-related abdominal pain. Results: Overall, 51.9% of the respondents reported abdominal pain in the last 3 months, and 11.0% belonged to the group with frequent meal-related abdominal pain, which included more females and younger subjects. DGBI diagnoses were more common in subjects with frequent meal-related abdominal pain, and the frequency of several GI symptoms was associated with having more frequent meal-related abdominal pain. Having meal-related abdominal pain more frequently was also associated with more severe psychological distress, non-GI somatic symptoms, and a poorer quality of life. The group with frequent meal-related abdominal pain also more often consulted a doctor for bowel problems compared to the other groups of meal-related abdominal pain. Conclusion: Reporting frequent meal-related abdominal pain is common across the globe and associated with other GI and non-GI somatic symptoms, psychological distress, healthcare utilization, and a poorer quality of life. Individuals who frequently experience meal-related abdominal pain also more frequently fulfill the diagnostic criteria for DGBI. Assessing meal-related symptoms in all DGBI patients could be of major importance to improve and individualizesymptom management. | We aimed to describe the global prevalence of meal-related abdominal pain and characterize this subgroup. | Reporting frequent meal-related abdominal pain is common across the globe and associated with other GI and non-GI somatic symptoms, psychological distress, healthcare utilization, and a poorer quality of life. Individuals who frequently experience meal-related abdominal pain also more frequently fulfill the diagnostic criteria for DGBI. Assessing meal-related symptoms in all DGBI patients could be of major importance to improve and individualize symptom management. |
| 6 | Dan L. Dumitrascu | Epidemiology and Burden of Disorders of Gut-Brain Interaction in Romania: A Subgroup Analysis of the Rome Foundation Global Epidemiology Study | 2022 | Dumitrascu, D. L., T. Freud, A. Ismaiel, S. I. Bangdiwala, O. S. Palsson and A. D. Sperber (2022). "Epidemiology and Burden of Disorders of Gut-Brain Interaction in Romania: A Subgroup Analysis of the Rome Foundation Global Epidemiology Study." J Gastrointestin Liver Dis 31(3): 273-282. | https://www.ncbi.nlm.nih.gov/pubmed/36004415 | Background & Aims: Disorders of gut-brain interaction (DGBI) are a group of chronic illnesses that are crucial to public health because they are widespread, influence patients' quality of life and functional level, and exert a major socioeconomic impact. We assessed the national prevalence of all 22 DGBI, the percentage of respondents satisfying diagnostic criteria for at least one DGBI, and the impact on the disease burden in Romania using data from the Rome Foundation Global Epidemiology Study. Methods: Data were collected through an anonymous, nationwide, and secure online survey, which evaluated the prevalence of any DGBI as well as over 22 different DGBI. The Rome IV diagnostic questionnaire and an in-depth supplemental questionnaire were included in the survey, which was completed through the Internet with numerous built-in quality-assurance measures. Results: The survey was completed by 2,049 participants (mean age 42.29±13.11 years) with a representative national distribution. Diagnostic criteria for any DGBI were met in 40.1% of the subjects, while 28.6% met criteria for only one DGBI (no overlap), and 11.5% met criteria for DGBIs in two, three, or four overlapping gastrointestinal anatomical regions. Females had a substantially higher predominance of DGBI than males. Psychosocial characteristics (such as quality of life, somatization, and concern about digestive problems) and healthcare utilization (such as physician visits and medication use) were associated with having any DGBI. Conclusions: We provide the first comprehensive evaluation of the prevalence and burden of DGBI in Romania using the Rome IV criteria. The burden of DGBI in Romania is substantial, with 40.1% of the 2,049 participants meeting diagnostic criteria for any DGBI. These findings demonstrate the importance of patient care, and the need for training and future research. | We assessed the national prevalence of all 22 DGBI in Romania | The burden of DGBI in Romania is substantial, with 40.1% of the 2,049 participants meeting diagnostic criteria for any DGBI. |
| 7 | I‐Hsuan Huang | Worldwide prevalence and burden of gastroparesis‐like symptoms as defined by the United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on gastroparesis | 2022 | Huang, I. H., J. Schol, R. Khatun, F. Carbone, K. Van den Houte, E. Colomier, L. M. Balsiger, H. Tornblom, T. Vanuytsel, E. Sundelin, M. Simren, O. S. Palsson, S. I. Bangdiwala, A. D. Sperber and J. Tack (2022). "Worldwide prevalence and burden of gastroparesis-like symptoms as defined by the United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on gastroparesis." United European Gastroenterol J 10(8): 888-897. | https://www.ncbi.nlm.nih.gov/pubmed/35985672 | Background/Objectives: The global epidemiology of gastroparesis is unknown. The European UEG and European Society for Neurogastroenterology and motility consensus defines Gastroparesis as a condition characterized by delayed gastric emptying in the absence of mechanical obstruction, with a symptom pattern of nausea and/or vomiting and overlapping postprandial distress syndrome (PDS). Real‐world evidence of this gastroparesis‐like symptom pattern is a crucial step in understanding the epidemiology of gastroparesis. Methods: In the Rome Foundation Global Epidemiology Study, 54,127 respondents from 26 countries completed the Rome IV Diagnostic Questionnaire and variables associated with disorders of gut‐brain interaction via Internet. We selected subjects with gastroparesis‐like symptoms (GPLS) (nausea and/or vomiting ≥1 day/week and simultaneous PDS). Patients reporting organic gastrointestinal disease, or fulfilling criteria for self‐induced vomiting, cyclic vomiting or cannabinoid hyperemesis syndrome were excluded. We determined prevalence, associated comorbidities, quality of life (QoL) (PROMIS Global‐10), symptoms of anxiety and depression (PHQ‐4), somatic symptoms (PHQ‐12), and healthcare utilization. Results: The global prevalence of GPLS was 0.9% overall and 1.3% among diabetic individuals. Subjects with GPLS showed frequent overlapping of epigastric pain syndrome and irritable bowel syndrome. Subjects with GPLS had significantly lower body mass index, QoL, more non‐gastrointestinal somatic complaints, symptoms of anxiety and depression, higher medication usage and doctor visits in the overall and diabetic population, compared to subjects without these symptoms. Conclusions: GPLS are common worldwide and more common in diabetic patients. The symptom complex is associated with multiple aspects of illness and an increasedhealthcare consumption. | We determined prevalence, associated comorbidities, quality of life, symptoms of anxiety and depression, somatic symptoms, and healthcare utilization in people living with gastroparesis. | GPLS are common worldwide and more common in diabetic patients. The symptom complex is associated with multiple aspects of illness and an increasedhealthcare consumption. |
| 8 | Yuying Luo | Global patterns of prescription pain medication usage in disorders of gut–brain interactions | 2023 | Luo, Y., S. A. Camey, S. I. Bangdiwala, O. S. Palsson, A. D. Sperber and L. A. Keefer (2023). "Global patterns of prescription pain medication usage in disorders of gut-brain interactions." Neurogastroenterol Motil 35(1): e14457. | https://www.ncbi.nlm.nih.gov/pubmed/36111642 | Background: Forty percent of individuals globally meet Rome IV criteria for a disorder of gut–brain interaction (DGBI). The global burden of pain across these disorders has not been characterized. Methods: Our study included 54,127 respondents from the 26 Internet survey countries. Prescription pain medication usage was selected as the proxy for pain. The associations between prescription pain medications and the environmental, sociodemographic, psychosocial, and DGBI diagnosis variables were investigated using the multivariate generalized robust Poisson regression model. Key Results: Respondents with DGBI used prescription pain medications at higher rates than those without a DGBI diagnosis with pooled prevalence rate of 14.8% (95% confidence interval [CI], 14.4–15.3%), varying by country from 6.8% to 25.7%. The pooled prevalence ratio of prescription pain medication usage in respondents with and without DGBI was 2.2 (95% CI: 2.1–2.4). Factors associated with higher prevalence of pain medication usage among respondents with a DGBI diagnosis included living in a small community, increased anxiety, depression or somatization, increased stress concern or embarrassment about bowel functioning and having more than one anatomic DGBI diagnosis. Conclusion: 14.8% of patients globally with at least one diagnosis of DGBI were on prescription pain medications with wide geographic variation, about twice as many as their counterparts without a diagnosis of DGBI. Environmental, sociodemographic, and individual factors may influence clinicians to consider personalized, multimodal approaches to address pain in patients with DGBI. | The associations between prescription pain medications and the environmental, sociodemographic, psychosocial, and DGBI diagnosis variables were investigated | 14.8% of patients globally with at least one diagnosis of DGBI were on prescription pain medications with wide geographic variation, about twice as many as their counterparts without a diagnosis of DGBI. Environmental, sociodemographic, and individual factors may influence clinicians to consider personalized, multimodal approaches to address pain in patients with DGBI. |
| 9 | Simon R. Knowles | Negative Impact of Disorders of Gut-Brain Interaction on Health-Related Quality of Life: Results From the Rome Foundation Global Epidemiology Survey | 2023 | Knowles, S. R., D. Skvarc, A. C. Ford, O. S. Palsson, S. I. Bangdiwala, A. D. Sperber and A. Mikocka-Walus (2023). "Negative Impact of Disorders of Gut-Brain Interaction on Health-Related Quality of Life: Results From the Rome Foundation Global Epidemiology Survey." Gastroenterology 164(4): 655-668 e610. | https://www.ncbi.nlm.nih.gov/pubmed/36565940 | BACKGROUND & AIMS: This study used the database from the Rome Foundation Global Epidemiology Survey to assess the differences in quality of life overall, and by age and sex, across individual disorders of gut-brain interaction (DGBI), gastrointestinal anatomical region(s), and number of overlapping DGBI. METHODS: Data were collected via the Internet in 26 countries, using the Rome IV diagnostic questionnaire and a supplemental questionnaire including the Patient-Reported Outcomes Measurement Information Systems Global-10 quality of life measure. Factorial analyses of variance were used to explore physical and mental quality of life, adjusting for multiple comparisons. RESULTS: Among the 54,127 respondents, quality of life deteriorated significantly with increasing number of overlapping DGBI, with respondents reporting 2 DGBI having significantly poorer quality of life than those with only 1 DGBI or those without any DGBI. Men with DGBI reported better quality of life than women, and those aged 65 years reported better quality of life than those <65 years. Age, sex, number of overlapping DGBI, somatization, anxiety, depression, and functional experiences (concern, embarrassment, or stress associated with bowel functioning) relating to DGBI, were significant predictors of poorer physical and mental quality of life. CONCLUSIONS: This study is the most comprehensive assessment of quality of life to date in adults living with a DGBI. It provides a representative picture of DGBI impact on adults in the global adult population and highlights the significant detrimental impact of living with a DGBI on quality of life. | This study assessed the differences in quality of life overall, and by age and sex, across individual disorders of gut-brain interaction (DGBI), gastrointestinal anatomical region(s), and number of overlapping DGBI. | his study used the database from the Rome Foundation Global Epidemiology Survey to assess the differences in quality of life overall, and by age and sex, across individual disorders of gut-brain interaction (DGBI), gastrointestinal anatomical region(s), and number of overlapping DGBI. |
| 10 | Johann P. Hreinsson | Factor Analysis of the Rome IV Criteria for Major Disorders of Gut-Brain Interaction (DGBI) Globally and Across Geographical, Sex, and Age Groups | 2023 | Hreinsson, J. P., H. Tornblom, J. Tack, D. A. Drossman, W. E. Whitehead, S. I. Bangdiwala, A. D. Sperber, O. S. Palsson and M. Simren (2023). "Factor Analysis of the Rome IV Criteria for Major Disorders of Gut-Brain Interaction (DGBI) Globally and Across Geographical, Sex, and Age Groups." Gastroenterology 164(7): 1211-1222. | https://www.ncbi.nlm.nih.gov/pubmed/36889555 | BACKGROUND & AIMS: The Rome criteria are widely accepted for diagnosing disorders of gut-brain interaction, but their global applicability has been debated. This study aimed to evaluate the validity of the Rome IV criteria by factor analysis globally, across geographical regions, by sex, and by age groups. METHODS: Data were collected in 26 countries using the Rome IV questionnaire. Forty-nine ordinal variables were used in exploratory factor analysis (EFA) to identify clusters of inter-correlated variables (factors) within the data set. Confirmatory factor analysis with predefined factors of the disorders of gut-brain interaction was compared with the factors in the EFA. Analyses were performed globally, for each geographical region (North and Latin America, Western and Eastern Europe, Middle East, Asia), sex, and age groups (18–34, 35–49, 50–64, 65). RESULTS: A total of 54,127 people were included. The EFA identified 10 factors accounting for 57% of the variance: irritable bowel syndrome, constipation, diarrhea, upper gastrointestinal symptoms, globus, regurgitation/retching, chest pain, nausea/vomiting, and 2 right upper quadrant pain factors. Most factors had close correspondence to a Rome IV criteria diagnosis, but notably, functional dysphagia and heartburn symptoms were often included in the same factor and/or in upper gastrointestinal symptoms. Most factors were consistent across geographical regions, sex, and age groups, and compatible to the global results. All prespecified factors in the confirmatory analysis had a loading 0.4, indicating validity of the Rome IV criteria. | This study aimed to evaluate the validity of the Rome IV criteria by factor analysis globally, across geographical regions, by sex, and by age groups | The results indicate that the Rome IV criteria for irritable bowel syndrome, functional dyspepsia, functional constipation, globus, and biliary pain are globally valid and represent universal diagnostic entities that are similar across sex and age groups. |
| 11 | Simon R. Knowles | The epidemioflogy and psychological comorbidity of disorders of gut–brain interaction in Australia: Results from the Rome Foundation Global Epidemiology Study | 2023 | Knowles, S. R., P. Apputhurai, O. S. Palsson, S. Bangdiwala, A. D. Sperber and A. Mikocka-Walus (2023). "The epidemiology and psychological comorbidity of disorders of gut-brain interaction in Australia: Results from the Rome Foundation Global Epidemiology Study." Neurogastroenterol Motil 35(6): e14594. | https://www.ncbi.nlm.nih.gov/pubmed/37052411 | Backround: The Rome Foundation Global Epidemiology Study on the disorders of gut–brain interaction (DGBI) was used to assess the national prevalence of all 22 DGBI, the percentage of respondents meeting diagnostic criteria for at least one DGBI, and the rates of comorbid anxiety, depression, and somatization in Australia and 25 other countries. Methods: The survey was conducted in Australia and 25 other countries through the Internet and included the Rome IV Diagnostic Questionnaire and an in-depth supplemental questionnaire.Key Results: Two thousand thirty-six Australian adults completed the survey nationwide: mean age 47.34 ± 17.00 years, 50.15% males. Overall, 38.67% of Australians met criteria for at least one DGBI, with unspecified functional bowel disorder (8.01%) and then functional constipation (7.71%) being the most prevalent. For those Australians with at least one DGBI, rates of anxiety, depression, and somatization where high (26.58%, 28.96%, and 63.10%, respectively), with functional chest pain having the highest rates of anxiety (55.00%) and depression (57.50%), and irritable bowel syndrome (mixed) having the highest somatization rate (75.86%). The odds of having a DGBI increased with greater anxiety (OR: 1.09, CI 95%: 0.97, 1.23), depression (OR: 1.17, CI 95%: 1.04, 1.32), and somatization (OR: 1.17, CI 95%: 1.14, 1.20) symptom severity. Conclusions and Inferences: The current study represents the most comprehensive epidemiological exploration of DGBI and mental health in Australia to date, including their prevalence and distributions across sex and age, associations between DGBI and anxiety, depression, and somatization. The findings warrants future comparisons between population characteristics and health care systems differences in order to reduce the burden of DGBI and mental illness worldwide. | We assessed the national prevalence of all 22 DGBI, the percentage of respondents meeting diagnostic criteria for at least one DGBI, and the rates of comorbid anxiety, depression, and somatization in Australia and 25 other countries. | The current study represents the most comprehensive epidemiological exploration of DGBI and mental health in Australia to date, including their prevalence and distributions across sex and age, associations between DGBI and anxiety, depression, and somatization. The findings warrants future comparisons between population characteristics and health care systems differences in order to reduce the burden of DGBI and mental illness worldwide. |
| 12 | Bert Broeders | Epidemiology of disorders of gut-brain interaction in Belgium and differences between two language groups: Results from the Rome foundation global epidemiology study | 2023 | Broeders, B., E. Devolder, M. Jones, M. Simren, S. I. Bangdiwala, A. D. Sperber, O. S. Palsson and J. Tack (2023). "Epidemiology of disorders of gut-brain interaction in Belgium and differences between two language groups: Results from the Rome foundation global epidemiology study." Neurogastroenterol Motil 35(6): e14588. | https://www.ncbi.nlm.nih.gov/pubmed/37018388 | Background: The Rome Foundation carried out a worldwide epidemiology study on DGBI according to the Rome IV criteria in 33 countries, including Belgium. DGBI prevalence varied between continents and countries, but prevalence differences within language groups in a single country have not yet been described. Methods: We analyzed the prevalence rates of 18 DGBI and their psychosocial impact in Belgium in the French and Dutch language groups. Key Results: DGBI prevalence was similar in the French-speaking and Dutch-speaking population. Having one or more DGBI was negatively associated with psychosocial well-being. The scores for depression were lower in the Dutch-speaking participants with one or more DGBI compared to the French-speaking participants. Interestingly, we also found significantly lower scores in the general Dutch-speaking versus the French-speaking population for depression and non-gastrointesinal somatic symptoms, and higher global physical health and mental health quality-of- life component scores. In the Dutch-speaking group, medication use for gastric acid was lower, but use of prescribed analgesics was more common. Nevertheless, the use of non-prescribed pain medication was higher in the French-speaking group. Anxiety and sleep medication use was also higher in the latter group. Conclusions & Interferences: The results of this first in-depth analysis of Rome IV DGBI in Belgium show a higher prevalence for some DGBI in the French-speaking cohort, and a larger associated disease burden. These differences between language/culture groups in the same country support the psychosocial pathophysiological model of DGBI. | The Rome Foundation carried out a worldwide epidemiology study on DGBI according to the Rome IV criteria in 33 countries, including Belgium. | The results of this first in-depth analysis of Rome IV DGBI in Belgium show a higher prevalence for some DGBI in the French-speaking cohort, and a larger associated disease burden. These differences between language/culture groups in the same country support the psychosocial pathophysiological model of DGBI. |
| 13 | David M. Rodrigues | The epidemiology and impact of disorders of gut–brain interaction in Canada: Results from the Rome Foundation Global Epidemiologic Study | 2023 | Rodrigues, D. M., P. Poitras, A. G. Day, A. D. Sperber, O. Palsson, S. I. Bangdiwala and S. J. Vanner (2023). "The epidemiology and impact of disorders of gut-brain interaction in Canada: Results from the Rome Foundation Global Epidemiologic Study." Neurogastroenterol Motil 35(6): e14585. | https://www.ncbi.nlm.nih.gov/pubmed/36989173 | Background: Using data from the Rome Foundation Global Epidemiology Study examining prevalence of disorders of gut–brain interaction (DGBI) in 33 countries, this study explored the prevalence of all 22 disorders in Canada. It examined differences related to geography and sociodemographic factors, health impact and compared these findings to other countries. Methods: The Rome Foundation survey was conducted through the Internet, targeting 2000 Canadian participants. The survey used the validated ROME IV diagnostic questionnaire to identify the 22 DGBI and an in-depth supplemental questionnaire that included quality assurance techniques. Key Results: There were 2029 respondents with a mean age of 48 years and 50% females. Diagnostic criteria for at least one of the 22 DGBI were met by 41.3%, similar to other countries. Functional constipation, functional diarrhea, and unspecified functional bowel disorders were most common. Irritable bowel syndrome prevalence was 4.2% using Rome IV and 10.1% using ROME III criteria. DGBI were associated with poorer quality of life and increased psychological symptom scores. Prevalence of DGBI ranged from 48% in Quebec to 36% in British Columbia. Prescription pain medication was reported by 17% with DGBI compared to 9% without DGBI and correlated negatively with mental health and physical well-being. Quebecers and francophones were in limited number but reported higher DGBI prevalence and symptom severity compared to others. Conclusions & Inferences: A large proportion of Canadians suffer from DGBI which seriously impact their well-being. Findings highlight the need for further research and education, including understanding whether significant regional and cultural differences contribute to DGBI. | This study explored the prevalence of all 22 DGBI in Canada. It examined differences related to geography and sociodemographic factors, health impact and compared these findings to other countries. | A large proportion of Canadians suffer from DGBI which seriously impact their well-being. Findings highlight the need for further research and education, including understanding whether significant regional and cultural differences contribute to DGBI. |
| 14 | Ami D. Sperber | Face-to-face interviews versus Internet surveys: Comparison of two data collection methods in the Rome foundation global epidemiology study: Implications for population-based research | 2023 | Sperber, A. D., S. Bor, X. Fang, S. I. Bangdiwala, D. A. Drossman, U. C. Ghoshal, M. Simren, J. Tack, W. E. Whitehead, D. L. Dumitrascu, S. Fukudo, J. Kellow, E. Okeke, E. M. M. Quigley, M. Schmulson, P. Whorwell, T. Archampong, P. Adibi, V. Andresen, M. A. Benninga, B. Bonaz, L. B. Fernandez, S. C. Choi, E. S. Corazziari, C. Francisconi, A. Hani, L. Lazebnik, Y. Y. Lee, A. Mulak, M. M. Rahman, J. Santos, M. Setshedi, A. F. Syam, S. Vanner, R. K. Wong, A. Lopez-Colombo, V. Costa, R. Dickman, M. Kanazawa, A. H. Keshteli, R. Khatun, I. Maleki, P. Poitras, N. Pratap, O. Stefanyuk, S. Thomson, M. Buyruk, N. Unal, D. Huang, J. Song, J. P. Hreinsson and O. S. Palsson (2023). "Face-to-face interviews versus Internet surveys: Comparison of two data collection methods in the Rome foundation global epidemiology study: Implications for population-based research." Neurogastroenterol Motil 35(6): e14583. | https://www.ncbi.nlm.nih.gov/pubmed/37018412 | Backgrounds and Aims: The Rome Foundation Global Epidemiology Study (RFGES) assessed the prevalence, burden, and associated factors of Disorders of Gut–Brain Interaction (DGBI) in 33 countries around the world. Achieving worldwide sampling necessitated use of two different surveying methods: In-person household interviews (9 countries) and Internet surveys (26 countries). Two countries, China and Turkey, were surveyed with both methods. This paper examines the differences in the survey results with the two methods, as well as likely reasons for those differences. Methods: The two RFGES survey methods are described in detail, and differences in DGBI findings summarized for household versus Internet surveys globally, and in more detail for China and Turkey. Logistic regression analysis was used to elucidate factors contributing to these differences. Results: Overall, DGBI were only half as prevalent when assessed with household vs Internet surveys. Similar patterns of methodology-related DGBI differences were seen within both China and Turkey, but prevalence differences between the survey methods were dramatically larger in Turkey. No clear reasons for outcome differences by survey method were identified, although greater relative reduction in bowel and anorectal versus upper gastrointestinal disorders when household versus Internet surveying was used suggests an inhibiting influence of social sensitivity. Conclusions: The findings strongly indicate that besides affecting data quality, manpower needs and data collection time and costs, the choice of survey method is a substantial determinant of symptom reporting and DGBI prevalence outcomes. This has important implications for future DGBI research and epidemiological research more broadly. | This paper examines the differences in the survey results collected by internet vs household interviews, as well as likely reasons for those differences. | The findings strongly indicate that besides affecting data quality, manpower needs and data collection time and costs, the choice of survey method is a substantial determinant of symptom reporting and DGBI prevalence outcomes. This has important implications for future DGBI research and epidemiological research more broadly. |
| 15 | Uday C Ghoshal | Comparisons of the Rome III and Rome IV criteria for diagnosis of irritable bowel syndrome in Indian and Bangladeshi communities and internal shifts in the diagnostic categories of bowel disorders of gut–brain interactions | 2023 | Ghoshal, U. C., M. M. Rahman, N. Pratap, A. Misra, S. A. Sarker, M. Hasan, S. I. Bangdiwala, O. S. Palsson and A. D. Sperber (2023). "Comparisons of the Rome III and Rome IV criteria for diagnosis of irritable bowel syndrome in Indian and Bangladeshi communities and internal shifts in the diagnostic categories of bowel disorders of gut-brain interactions." Neurogastroenterol Motil 35(6): e14579. | https://www.ncbi.nlm.nih.gov/pubmed/37010834 | Background: Although the Rome IV criteria are the most recent criteria to diagnose irritable bowel syndrome (IBS), their sensitivity has been shown to be low in Chinese and Western populations. There are scanty data comparing the Rome III and Rome IV criteria in diagnosis of IBS in the Indian and Bangladeshi populations where abdominal pain, an essential component of diagnosis of IBS by the Rome IV criteria, is less in frequency and of lower severity. Methods: We analyzed the Indian and Bangladeshi data from the Rome Global Epidemiology Study to compare diagnostic sensitivity of the Rome III and Rome IV criteria for IBS, internal shifts in diagnostic categories of disorders of gut–brain interaction (DGBI), the severity of IBS diagnosed by the Rome III and Rome IV criteria, and consultation patterns in these populations. Key Results: The Rome IV criteria were less sensitive than the Rome III criteria to diagnose IBS in these populations, and the subjects with Rome III IBS shifted internally to other DGBI when the Rome IV criteria were applied. Moreover, Rome IV IBS subjects had greater symptom severity than the Rome III IBS. A third of people fulfilling diagnostic criteria for IBS consulted doctors, and those diagnosed using Rome IV criteria, those with higher anxiety and depression symptom score, lower global physical health score, and greater IBS symptom severity score had greater correlation coefficients with doctors' consultation. Conclusions and Inferences: The Rome IV diagnostic criteria for IBS are less sensitive than the Rome III criteria in Indian and Bangladesh communities. Application of the Rome IV criteria to people who meet the Rome III IBS criteria selects a subgroup of people with greater severity of symptoms, and hence, Rome IV IBS is more strongly associated with physician consultation. These findings may have important bearing in future iterations of the Rome criteria for a broader global applicability. | We compared the Rome III and Rome IV criteria in diagnosis of IBS in the Indian and Bangladeshi populations where abdominal pain, an essential component of diagnosis of IBS by the Rome IV criteria, is less in frequency and of lower severity. | Conclusions and Inferences: The Rome IV diagnostic criteria for IBS are less sensitive than the Rome III criteria in Indian and Bangladesh communities. Application of the Rome IV criteria to people who meet the Rome III IBS criteria selects a subgroup of people with greater severity of symptoms, and hence, Rome IV IBS is more strongly associated with physician consultation. These findings may have important bearing in future iterations of the Rome criteria for a broader global applicability. |
| 16 | Ami D. Sperber | The Rome Foundation Global Epidemiology study: Conception, implementation, results, and future potential | 2023 | Sperber, A. D. (2023). "The Rome Foundation Global Epidemiology study: Conception, implementation, results, and future potential." Neurogastroenterol Motil 35(6): e14567. | https://www.ncbi.nlm.nih.gov/pubmed/36989175 | Background: Methodological problems have impeded successful epidemiological research into disorders of gut-brain interactions (DGBI), as previous studies were limited in terms of study population, diagnostic criteria, number of disorders assessed, data collection methods, and geographic area. Most prevalence estimates were based on pooling data from heterogeneous studies using inappropriate pooling methods, seriously limiting the relevance of the results. The Rome Foundatiion Global Epidemiology Study (RFGES) aimed to rectify these limitations using rigorous methodology to survey the prevalence of 22 DGBI in large population samples in 33 countries. Its aims were to conduct a comprehensive, multinational epidemiological study using rigorous research methodology, gain a better understanding of the burden of the DGBI, gain reliable regional estimates of DGBI prevalence, and advance our understanding of the pathophysiology of IBS. The study questionnaire consisted of the 89-item Rome IV Adult Diagnostic Questionnaire enabling the diagnosis of 22 DGBI, and an 80-item supplemental questionnaire that enabled analyses of the association of multiple factors with DGBI diagnoses. Purpose for review article: This review paper introduces a special issue on the Rome Foundation Global Epidemiology study (RFGES) with a narrative description of its conception, development, and implementation, its outcomes to date, and its potential contribution to neurogastroenterology. It includes 15 papers that reflect the range of RFGES studies from single country papers to intra-regional studies, to inter-regional studies, and one global study. | Our aim was to conduct a comprehensive, multinational epidemiological study using rigorous research methodology, gain a better understanding of the burden of the DGBI, gain reliable regional estimates of DGBI prevalence, and advance our understanding of the pathophysiology of IBS. | This review paper introduces a special issue on the Rome Foundation Global Epidemiology study (RFGES) with a narrative description of its conception, development, and implementation, its outcomes to date, and its potential contribution to neurogastroenterology. It includes 15 papers that reflect the range of RFGES studies from single country papers to intra-regional studies, to inter-regional studies, and one global study. |
| 17 | Shin Fukudo | Characteristics of disorders of gut–brain interaction in the Japanese population in the Rome Foundation Global Epidemiological Study | 2023 | Fukudo, S., K. Nakaya, T. Muratsubaki, N. Nakaya, A. Hozawa, S. I. Bangdiwala, O. S. Palsson, A. D. Sperber and M. Kanazawa (2023). "Characteristics of disorders of gut-brain interaction in the Japanese population in the Rome Foundation Global Epidemiological Study." Neurogastroenterol Motil 35(6): e14581. | https://www.ncbi.nlm.nih.gov/pubmed/37093785 | Background: The aims were to use Japanese data from the Rome Foundation Global Epidemiological Study (RFGES) to test the hypotheses that severity of gastrointestinal (GI) symptoms and psychosocial disturbance are ordered as Rome IV irritable bowel syndrome (IBS) > Rome III IBS > DGBI, not IBS > others. Methods: Subjects were 2504 Japanese in the RFGES. We assessed DGBI/IBS diagnoses with Rome IV/III, IBS Symptom Severity Scale (IBS-SSS), Patient Health Questionnaire (PHQ) for anxiety/depression and non-GI somatic symptoms, PROMIS-10 for quality of life (QOL), Work Productivity and Activity Impairment (WPAI) Questionnaire, parts of Self-reported IBS Questionnaire (SIBSQ) for meal effect and stress effect, Food Frequency Questionnaire, and medication questions. Key Results: The prevalence of Rome IV DGBI was as follows; IBS-C 0.5%, IBS-D 0.8%, IBS-M 0.8%, IBS-U 0.1%, unspecified functional bowel disorder 10.7%, postprandial distress syndrome 2.2%, and epigastric pain syndrome 0.3%. Rome III IBS prevalence; IBS-C 3.0%, IBS-D 3.1%, IBS-M 2.7%, and IBS-U 0.6%. Comparison among Rome IV IBS (n = 54), Rome III IBS (n = 197), other DGBI (n = 746), others (n = 1389) revealed significant order as Rome IV IBS > Rome III IBS > other DGBI > others in IBS-SSS, anxiety/ depression, activity impairment, non-GI symptoms, physical QOL, mental QOL, exacerbated symptoms by meals and perceived stress (all p < 0.001). Conclusions & Inferences: These findings support the study hypotheses. Data from Japan as a culturally homogenous country suggest Rome IV IBS is more severe and hence has more gut–brain psychobehavioral involvement than Rome III IBS. | The aims were to use Japanese data from the Rome Foundation Global Epidemiological Study (RFGES) to test the hypotheses that severity of gastrointestinal (GI) symptoms and psychosocial disturbance are ordered as Rome IV irritable bowel syndrome (IBS) > Rome III IBS > DGBI, not IBS > others. | These findings support the study hypotheses. Data from Japan as a culturally homogenous country suggest Rome IV IBS is more severe and hence has more gut–brain psychobehavioral involvement than Rome III IBS. |
| 18 | Max J. Schmulson | Comparison of the epidemiology of disorders of gut–brain interaction in four Latin American countries: Results of The Rome Foundation Global Epidemiology Study | 2023 | Schmulson, M. J., G. A. Puentes-Leal, L. Bustos-Fernandez, C. Francisconi, A. Hani, A. Lopez-Colombo, O. S. Palsson, S. I. Bangdiwala and A. D. Sperber (2023). "Comparison of the epidemiology of disorders of gut-brain interaction in four Latin American countries: Results of The Rome Foundation Global Epidemiology Study." Neurogastroenterol Motil 35(6): e14569. | https://www.ncbi.nlm.nih.gov/pubmed/36989176 | Background: In Latin America, there are scarce data on the epidemiology of DGBI. The Rome Foundation Global Epidemiology Study (RFGES) Internet survey included 26 countries, four from Latin America: Argentina, Brazil, Colombia, and Mexico, with a 40.3% prevalence of Rome IV DGBI. We aimed at comparing the prevalence of DGBI and associated factors among these countries. Methods: The frequency of DGBI by anatomical region, specific diagnoses, sex, age, diet, healthcare access, anxiety, depression, and HRQOL, were analyzed and compared. Results: Subjects included Argentina n = 2057, Brazil = 2004, Colombia = 2007, and Mexico = 2001. The most common DGBI were bowel (35.5%), gastroduodenal (11.9%), and anorectal (10.0%). Argentina had the highest prevalence of functional diarrhea (p = 0.006) and IBS-D; Brazil, esophageal, gastroduodenal disorders, and functional dyspepsia; Mexico functional heartburn (all <0.001). Overall, DGBI were more common in women vs. men and decreased with age. Bowel disorders were more common in the 18–39 (46%) vs. 40–64- year (39%) groups. Diet was also different between those with DGBI vs. those without with subtle differences between countries. Subjects endorsing criteria for esophageal, gastroduodenal, and anorectal disorders | Internet survey included 26 countries, four from Latin America: Argentina, Brazil, Colombia, and Mexico, with a 40.3% prevalence of Rome IV DGBI. We aimed at comparing the prevalence of DGBI and associated factors among these countries. | Bowel disorders were more common in the 18–39 (46%) vs. 40–64- year (39%) groups. Diet was also different between those with DGBI vs. those without with subtle differences between countries. Subjects endorsing criteria for esophageal, gastroduodenal, and anorectal disorders |
| 19 | Max J. Schmulson | Pictograms to assess bloating and distension symptoms in the general population in Mexico: Results of The Rome Foundation Global Epidemiology Study | 2023 | Schmulson, M. J., A. Lopez-Colombo, A. Montiel Jarquin, G. A. Puentes-Leal, O. S. Palsson, S. I. Bangdiwala and A. D. Sperber (2023). "Pictograms to assess bloating and distension symptoms in the general population in Mexico: Results of The Rome Foundation Global Epidemiology Study." Neurogastroenterol Motil 35(6): e14577. | https://www.ncbi.nlm.nih.gov/pubmed/37010874 | Background: There is no term for bloating in Spanish and distension is a very technical word. "Inflammation"/"swelling" are the most frequently used expressions for bloating/ distension in Mexico, and pictograms are more effective than verbal descriptors (VDs) for bloating/distension in general GI and Rome III-IBS patients. However, their effectiveness in the general population and in subjects with Rome IV-DGBI is unknown. We analyzed the use of pictograms for assessing bloating/distension in the general population in Mexico. Methods: The Rome Foundation Global Epidemiology Study (RFGES) in Mexico (n = 2001) included questions about the presence of VDs "inflammation"/"swelling" and abdominal distension, their comprehension, and pictograms (normal, bloating, distension, both). We compared the pictograms with the Rome IV question about the frequency of experiencing bloating/distension, and with the VDs. Key Results: "Inflammation"/"swelling" was reported by 51.5% and distension by 23.8% of the entire study population; while 1.2% and 25.3% did not comprehend "Inflammation"/"swelling" or distension, respectively. Subjects without (31.8%) or not comprehending "inflammation"/"swelling"/distension (68.4%) reported bloating/distension by pictograms. Bloating and/or distension by the pictograms were much more frequent in those with DGBI: 38.3% (95%CI: 31.7–44.9) vs. without: 14.5% (12.0–17.0); and in subjects with distension by VDs: 29.4% (25.4–33.3) vs. without: 17.2% (14.9–19.5). D2 east (71.4%). Conclusions & Inferences: Pictograms are more effective than VDs for assessing the presence of bloating/distension in Spanish Mexico. Therefore, they should be used to study these symptoms in epidemiological research. | We analyzed the use of pictograms for assessing bloating/distension in the general population in Mexico. | Pictograms are more effective than VDs for assessing the presence of bloating/distension in Spanish Mexico. Therefore, they should be used to study these symptoms in epidemiological research. |
| 20 | Agata Mulak | Sex-and gender-related differences in the prevalence and burden of disorders of gut-brain interaction in Poland | 2023 | Mulak, A., T. Freud, M. Waluga, S. I. Bangdiwala, O. S. Palsson and A. D. Sperber (2023). "Sex- and gender-related differences in the prevalence and burden of disorders of gut-brain interaction in Poland." Neurogastroenterol Motil 35(6): e14568. | https://www.ncbi.nlm.nih.gov/pubmed/36989186 | Background: The aim of the study was to assess sex-and gender-related differences in the epidemiology and impact of disorders of gut–brain interaction (DGBI) in Poland. Methods: Data used for the current analysis were derived from the Polish population sample of 2057 subjects (1030 F, 1027 M) collected via the Internet survey that included the Rome IV diagnostic questionnaire and 80 supplementary questions. Key Results: The overall prevalence of DGBI in Poland was 46.0% (51.7% in women and 40.3% in men, p < 0.001). Comparing women versus men, esophageal disorders were observed in 6.3% vs. 6.0%, respectively (p > 0.05), gastroduodenal disorders in 14.0% vs. 7.8% (p < 0.001), bowel disorders in 44.3% vs. 33.9% (p < 0.001), and anorectal disorders in 9.9% vs. 7.7% (p > 0.05). The six most common DGBI included functional constipation 14.2%, functional dyspepsia 8.3%, proctalgia fugax 6.6%, functional bloating 4.8%, functional diarrhea 4.5%, and irritable bowel syndrome (IBS) 4.4%. All these disorders, except for functional diarrhea, were more common in women. The DGBI overlap was significantly higher in women than in men (16.7% vs.11.2%, p < 0.001). A higher number of overlapping DGBI correlated positively with IBS severity, higher level of somatization, anxiety and depression, poorer quality of life (QoL), and increased healthcare utilization. Conclusions and Inferences: This is the first comprehensive report on significant sex/gender-related differences in the prevalence and burden of DGBI in Poland. The revealed differences between women and men with DGBI in the clinical profile, psychosocial variables, and healthcare utilization may have important diagnostic and therapeutic implications. | The aim of the study was to assess sex-and gender-related differences in the epidemiology and impact of disorders of gut–brain interaction (DGBI) in Poland. | This is the first comprehensive report on significant sex/gender-related differences in the prevalence and burden of DGBI in Poland. The revealed differences between women and men with DGBI in the clinical profile, psychosocial variables, and healthcare utilization may have important diagnostic and therapeutic implications. |
| 21 | Joel Flores-Arriaga | Prevalence and description of disorders of gut–brain interaction in Spain according to the results of the Rome Foundation Global Epidemiology Study | 2023 | Flores-Arriaga, J., M. C. Aso, A. Izagirre, A. D. Sperber, O. S. Palsson, S. I. Bangdiwala, A. Lanas, L. Bujanda, B. Lobo, C. Alonso-Cotoner, A. Sanchez-Pla and J. Santos (2023). "Prevalence and description of disorders of gut-brain interaction in Spain according to the results of the Rome Foundation Global Epidemiology Study." Neurogastroenterol Motil 35(6): e14582. | https://www.ncbi.nlm.nih.gov/pubmed/37010843 | Background: Data for Spain from the Rome Foundation Global Epidemiology Study on the disorders of gut–brain interaction (DGBI) were used to assess the national and regional prevalence of all 22 DGBI, the percentage of respondents meeting diagnostic criteria for at least one DGBI, and the impact on burden of disease in our country. Methods: Data were collected through an anonymous, nationwide, and secure Internet survey with multiple built-in quality-assurance techniques that included the Rome IV diagnostic questionnaire and an in-depth supplemental questionnaire. Key Results: The survey was completed by 2072 adult Spanish participants (50.2% female) with a mean age of 45.67 ± 15.44 years with a good representative national distribution. 43.6% (41.5%–45.8%) met diagnostic criteria for at least one DGBI, with 8.2% for any esophageal disorder, 12.1% for any gastroduodenal disorder, 30.1% for any bowel disorder, and 11.5% for any anorectal disorder. Functional constipationwas the most prevalent DGBI in Spain (12.8%). We found that proctalgia fugax (9.3%), unspecified bowel disorders (10.8%), and functional dysphagia (5.6%) showed unexplained high rates in our country. DGBI rates were higher for women. Having any DGBI was negatively associated with psychosocial variables (including quality of life, somatization, and concern about digestive problems), and associated with increased healthcare utilization. Conclusions & Inferences: We provide the first comprehensive data on the prevalence and burden of all DGBI in Spain using the Rome IV criteria. The enormous burden of DGBI in Spain highlights the need for specialized training and future research. | Data for Spain from the Rome Foundation Global Epidemiology Study on the disorders of gut–brain interaction (DGBI) were used to assess the national and regional prevalence of all 22 DGBI, the percentage of respondents meeting diagnostic criteria for at least one DGBI, and the impact on burden of disease in our country. | We provide the first comprehensive data on the prevalence and burden of all DGBI in Spain using the Rome IV criteria. The enormous burden of DGBI in Spain highlights the need for specialized training and future research. |
| 22 | Navkiran Thind Tornkvist | Prevalence and impact of disorders of Gut–Brain interaction in Sweden | 2023 | Tornkvist, N. T., M. Simren, J. P. Hreinsson, J. Tack, S. I. Bangdiwala, A. D. Sperber, O. S. Palsson, A. Josefsson and H. Tornblom (2023). "Prevalence and impact of disorders of Gut-Brain interaction in Sweden." Neurogastroenterol Motil 35(6): e14578. | https://www.ncbi.nlm.nih.gov/pubmed/37018426 | Background: Previous epidemiologic studies in Sweden have only covered some of the disorders of gut–brain interaction (DGBI) and are not representative of the general population. This study aimed to define the prevalence and impact of DGBI in Sweden. Methods: We used Swedish data from the Rome Foundation Global Epidemiology Study which include information on DGBI diagnoses, psychological distress, quality of life (QoL), healthcare utilization, and the impact of stress on GI symptoms. Key Results: The prevalence of having any DGBI was 39.1% (95% CI 37.0–41.2); esophageal disorders 6.1% (5.1–7.3), gastroduodenal disorders 10.7% (9.3–12.0), bowel disorders 31.6% (29.6–33.6), and anorectal disorders 6.0% (5.1–7.2). Subjects with a DGBI more commonly reported anxiety and/or depression, reduced mental and physical QoL, and more frequent doctor visits due to health problems. Subjects with a DGBI reported bothersome gastrointestinal (GI) symptoms to a greater extent and more than 1/3 had visited a doctor due to GI problems and of those 1/3 had seen multiple doctors. Prescription medications were available among 36.4% (31.0–42.0) who had bothersome GI symptoms and a DGBI, with sufficient symptom relief in 73.2% (64.0–81.1). Psychological factors and eating were reported to worsen GI symptoms and stress during the last month was greater in subjects with a DGBI. Conclusions and Inferences: DGBI prevalence and its impact in Sweden is in line with global data, including increased healthcare utilization. GI symptoms are commonly affected by psychological factors and eating, and a high proportion of those on prescription medication report sufficient GI symptom relief. | This study aimed to define the prevalence and impact of DGBI in Sweden. | DGBI prevalence and its impact in Sweden is in line with global data, including increased healthcare utilization. GI symptoms are commonly affected by psychological factors and eating, and a high proportion of those on prescription medication report sufficient GI symptom relief. |
| 23 | Hussain Jaafari | The national prevalence of disorders of gut brain interaction in the United Kingdom in comparison to their worldwide prevalence: Results from the Rome foundation global epidemiology study | 2023 | Jaafari, H., L. A. Houghton, R. M. West, A. Agrawal, I. Aziz, C. J. Black, M. Corsetti, F. Shuweihdi, M. Eugenicos, P. A. Paine, A. C. Ford, P. J. Whorwell, S. I. Bangdiwala, O. S. Palsson, A. D. Sperber and D. H. Vasant (2023). "The national prevalence of disorders of gut brain interaction in the United Kingdom in comparison to their worldwide prevalence: Results from the Rome foundation global epidemiology study." Neurogastroenterol Motil 35(6): e14574. | https://www.ncbi.nlm.nih.gov/pubmed/37018424 | Background: There are minimal epidemiological data comparing the burden of disorders of gut brain interaction (DGBI) in the UK with other countries. We compared the prevalence of DGBI in the UK with other countries that participated in the Rome Foundation Global Epidemiology Study (RFGES) online. Methods: Participants from 26 countries completed the RFGES survey online including the Rome IV diagnostic questionnaire and an in-depth supplemental questionnaire with questions about dietary habits. UK sociodemographic and prevalence data were compared with the other 25 countries pooled together. Key Results: The proportion of participants with at least one DGBI was lower in UK participants compared with in the other 25 countries (37.6% 95% CI 35.5%–39.7% vs. 41.2%; 95% CI 40.8%–41.6%, p = 0.001). The UK prevalence of 14 of 22 Rome IV DGBI, including irritable bowel syndrome (4.3%) and functional dyspepsia (6.8%), was similar to the other countries. Fecal incontinence, opioid-induced constipation, chronic nausea and vomiting, and cannabinoid hyperemesis (p < 0.05) were more prevalent in the UK. Cyclic vomiting, functional constipation, unspecified functional bowel disorder, and proctalgia fugax (p < 0.05) were more prevalent in the other 25 countries. Diet in the UK population consisted of higher consumption of meat and milk (p < 0.001), and lower consumption of rice, fruit, eggs, tofu, pasta, vegetables/ legumes, and fish (p < 0.001). Conclusions and Inferences: The prevalence and burden of DGBI is consistently high in the UK and in the rest of the world. Opioid prescribing, cultural, dietary, and lifestyle factors may contribute to differences in the prevalence of some DGBI between the UK and other countries. | We compared the prevalence of DGBI in the UK with other countries that participated in the Rome Foundation Global Epidemiology Study (RFGES) online. | The prevalence and burden of DGBI is consistently high in the UK and in the rest of the world. Opioid prescribing, cultural, dietary, and lifestyle factors may contribute to differences in the prevalence of some DGBI between the UK and other countries. |
| 24 | Olafur S. Palsson | Prevalence and associated factors of disorders of gut-brain interaction in the United States: Comparison of two nationwide Internet surveys | 2023 | Palsson, O. S., A. D. Sperber, S. Bangdiwala and W. E. Whitehead (2023). "Prevalence and associated factors of disorders of gut-brain interaction in the United States: Comparison of two nationwide Internet surveys." Neurogastroenterol Motil 35(6): e14564. | https://www.ncbi.nlm.nih.gov/pubmed/36961084 | Background: No comprehensive assessment of disorders of gut-brain interaction (DGBI) in the United States (US) national population has been published in the past three decades. We aimed to provide an updated picture of DGBI in the United States and associated factors, using data from two national Internet surveys. Methods: Data were analyzed from 1949 people surveyed in 2015, and 2023 people surveyed in 2017 as a part of the Rome Foundation Global Epidemiology Study (RFGES). The surveys had nearly identical methodology and included the Rome IV Diagnostic Questionnaire and questions on demographics, quality of life (QoL), emotional symptoms, and healthcare utilization. Key Results: The prevalence of having any DGBI was 36.0% and 39.9% in the two surveys. Prevalence estimates for the 22 DGBI assessed were broadly comparable between the surveys, as their 95% confidence intervals overlapped for every disorder. Females had DGBI more commonly than males in both surveys (odds ratios 1.66 and 1.52), and people of age 65 and older had lower DGBI prevalence than younger age groups. Having DGBI was associated in both surveys with significant QoL impairment, elevated anxiety, depression and somatization symptoms, and increased doctor visits. Conclusions and Inferences: Approximately 4 out of every 10 US adults have a DGBI; more commonly women and people under the age of 65. DGBI adversely affect QoL and emotional well-being and increase healthcare needs. The similarity of findings between the two surveys supports the reliability of DGBI prevalence estimates obtained with the Internet survey method used globally in the RFGES. | We aimed to provide an updated picture of DGBI in the United States and associated factors, using data from two national Internet surveys. | Approximately 4 out of every 10 US adults have a DGBI; more commonly women and people under the age of 65. DGBI adversely affect QoL and emotional well-being and increase healthcare needs. The similarity of findings between the two surveys supports the reliability of DGBI prevalence estimates obtained with the Internet survey method used globally in the RFGES. |
| 25 | Johann P. Hreinsson | A comparative study of disorders of gut–brain interaction in Western Europe and Asia based on the Rome foundation global epidemiology study | 2023 | Hreinsson, J. P., R. K. M. Wong, J. Tack, P. Whorwell, M. A. Benninga, V. Andresen, B. Bonaz, S. C. Choi, E. S. Corazziari, J. Santos, S. Fukudo, M. Kanazawa, X. Fang, S. I. Bangdiwala, A. D. Sperber, O. S. Palsson and M. Simren (2023). "A comparative study of disorders of gut-brain interaction in Western Europe and Asia based on the Rome foundation global epidemiology study." Neurogastroenterol Motil 35(6): e14566. | https://www.ncbi.nlm.nih.gov/pubmed/36961016 | Objective: Many studies have been published on disorders of the gut–brain interaction (DGBI) in Asia and Western Europe, but no previous study has directly assessed the difference between the two regions. The aim was to compare the prevalence of DGBI in Asia and Western Europe. Methods: We used data collected in a population-based Internet survey, the Rome Foundation Global Epidemiology Study, from countries in Western Europe (Belgium, France, Germany, Netherlands, Italy, Spain, Sweden, and the United Kingdom) and Asia (China, Japan, South Korea, and Singapore). We assessed DGBI diagnoses (Rome IV Adult Diagnostic Questionnaire), anxiety/depression (Patient Health Questionnaire-4, PHQ-4), non-GI somatic symptoms (PHQ-12), and access to and personal costs of doctor visits. Results: The study included 9487 subjects in Asia and 16,314 in Western Europe. Overall, 38.0% had at least one DGBI; younger age, female sex, and higher scores on PHQ4 and PHQ12 were all associated with DGBI. The prevalence of having at least one DGBI was higher in Western Europe than in Asia (39.1% vs 36.1%, OR 1.14 [95% CI 1.08–1.20]). This difference was also observed for DGBI by anatomical regions, most prominently esophageal DGBI (OR 1.67 [1.48–1.88]). After adjustment, the difference in DGBI prevalence diminished and psychological (PHQ-4) and non-GI somatic symptoms (PHQ-12) had the greatest effect on the odds ratio estimates. Conclusion: The prevalence of DGBI is generally higher in Western Europe compared to Asia. A considerable portion of the observed difference in prevalence rates seems to be explained by more severe psychological and non-GI somatic symptoms in Western Europe. | The aim was to compare the prevalence of DGBI in Asia and Western Europe. | The prevalence of DGBI is generally higher in Western Europe compared to Asia. A considerable portion of the observed difference in prevalence rates seems to be explained by more severe psychological and non-GI somatic symptoms in Western Europe. |
| 26 | Åsa Frändemark | Work productivity and activity impairment in disorders of gut‐brain interaction: Data from the Rome Foundation Global Epidemiology Study | 2023 | Frandemark, A., H. Tornblom, J. P. Hreinsson, V. Andresen, M. A. Benninga, E. S. Corazziari, S. Fukudo, A. Mulak, J. Santos, A. D. Sperber, S. I. Bangdiwala, O. S. Palsson and M. Simren (2023). "Work productivity and activity impairment in disorders of gut-brain interaction: Data from the Rome Foundation Global Epidemiology Study." United European Gastroenterol J 11(6): 503-513. | https://www.ncbi.nlm.nih.gov/pubmed/37332146 | Background: Disorders of Gut‐Brain Interaction (DGBI) are highly prevalent worldwide, but their effect on work productivity has not gained much attention. Aims and Methods: We aimed to compare work productivity and activity impairment (WPAI) in persons with and without DGBI in a large population‐based cohort and identify factors independently associated with WPAI in subjects with DGBI. Data were collected from Germany, Israel, Italy, Japan, the Netherlands, Poland, Spain and Sweden via Internet surveys as part of the Rome Foundation Global Epidemiology Study. Apart from the Rome IV diagnostic questionnaire, questionnaires evaluating WPAI related to general health (WPAI:GH), psychological distress (PHQ‐4), somatic symptom severity (PHQ‐15) and other factors were assessed. Results: Of the 16,820 subjects, 7111 met the criteria for DGBI according to the Rome IV diagnostic questionnaire. Subjects with DGBI were younger (median (interquartile range) age 43 (31–58) vs. 47 (33–62)) and more often female (59.0% vs. 43.7%) compared to subjects without DGBI. Subjects with DGBI had higher absenteeism, presenteeism (poor work productivity due to illness), overall work impairment and activity impairment (p < 0.001) compared with subjects without. For subjects with DGBI affecting more than one anatomical region, WPAI was incrementally higher for each additional region. There were significant differences in WPAI for subjects with DGBI in different countries. Subjects from Sweden had the highest overall work impairment and from Poland the lowest. Using multiple linear regression, male sex, fatigue, psychological distress, somatic symptom severity and number of anatomical regions were independently associated with overall work impairment (p < 0.05 for all). Conclusion: In the general population, people with DGBI have substantial WPAI compared with those without DGBI. The reasons for these findings should be explored further, but having multiple DGBI, psychological distress, fatigue and somatic symptom severity seem to contribute to this impairment associated with DGBI. | We aimed to determine the effect of DGBI on work productivity globally | In the general population, people with DGBI have substantial WPAI compared with those without DGBI. The reasons for these findings should be explored further, but having multiple DGBI, psychological distress, fatigue and somatic symptom severity seem to contribute to this impairment associated with DGBI. |
| 27 | Sarah Ballou | Prevalence and Associated Factors of Bloating: Results From the Rome Foundation Global Epidemiology Study | 2023 | Ballou, S., P. Singh, J. Nee, V. Rangan, J. Iturrino, G. Geeganage, B. Lowe, S. I. Bangdiwala, O. S. Palsson, A. D. Sperber, A. Lembo and M. Lehmann (2023). "Prevalence and Associated Factors of Bloating: Results From the Rome Foundation Global Epidemiology Study." Gastroenterology 165(3): 647-655 e644. | https://www.ncbi.nlm.nih.gov/pubmed/37315866 | BACKGROUND & AIMS: Bloating is a common symptom in the general population and among disorders of gut–brain interaction, although its prevalence has not been well characterized. The aim of this study was to report the prevalence of bloating as a symptom in the worldwide population and to identify factors associated with this symptom in the general population. METHODS: Rome Foundation Global Epidemiology Study internet survey data were analyzed. After excluding respondents with potential organic causes of bowel symptoms, the current analysis included 51,425 individuals in 26 countries. Data included diet, medical history, quality of life, and Rome IV diagnostic questions. Presence of bloating was defined as experiencing bloating at least once per week for the last 3 months. Descriptive statistics estimated prevalence by country, region, and disorder of gut–brain interaction diagnosis. Logistic regression evaluated predictors of bloating. RESULTS: Nearly 18% of the global study population reported bloating (ranging from 11% in East Asia to 20% in Latin America). Prevalence decreased with age and women were approximately twice as likely as men to report bloating. More than one-half of respondents who reported weekly epigastric pain (71.39%), nausea (59.7%), or abdominal pain (61.69%) also reported bloating at least once per week. In logistic regression, the strongest associations were with abdominal pain (odds ratio, 2.90) and epigastric pain (odds ratio, 2.07). CONCLUSIONS: Bloating is common throughout the world. Nearly 18% of the general population experience bloating at least once per week. Reported bloating prevalence is lower in older age groups, most common in women, and strongly associated with abdominal pain. | The aim of this study was to report the prevalence of bloating as a symptom in the worldwide population and to identify factors associated with this symptom in the general population. | Bloating is common throughout the world. Nearly 18% of the general population experience bloating at least once per week. Reported bloating prevalence is lower in older age groups, most common in women, and strongly associated with abdominal pain. |
| 28 | Jan Tack | The Rome Foundation Global Epidemiology study: Research opportunities national and worldwide | 2022 | Tack J and D. A. Drossman (2022). "The Rome Foundation Global Epidemiology study: Research opportunities national and worldwide." Neurogastroenterol Motil 34(8): e14431. | https://www.ncbi.nlm.nih.gov/pubmed/35811414 | The Rome Foundation embarked on an ambitious multi-year, multinational population-based study to evaluate the prevalence of Rome IV-defined DGBI and their biopsychosocial impact on a worldwide scale. The consistency of the study findings attests to the scientific rigor of this effort, as evident in the publications that resulted from this international study. Dr. Sperber and colleagues report a subanalysis on the Rome IV Global Epidemiology internet survey of the 2012 adults in Israel. These data determined the national prevalence of Rome IV-defined DGBIs, and their associated healthcare utilization and sociodemographic and psychosocial variables. Importantly, they also permitted seamless comparison of the data in the rest of the world. The Israeli study highlights some of the strengths of the Global Epidemiology Study: the 2 respondents had a geographical spread representative of the country. The questionnaire in Israel was available to the participants online in four different languages used by the population in Israel: The database of the study is now available through the Rome Foundation Research Institute for use by academic and industry researchers. This unique gift from the Rome Foundation to the scientific community no doubt will further enhance our understanding of disorders of gut-brain interaction. | We describe the global epidemiology database available to researchers through the Rome Foundation Research Institute. | These data determined the national prevalence of Rome IV-defined DGBIs, and their associated healthcare utilization and sociodemographic and psychosocial variables. Importantly, they also permitted seamless comparison of the data in the rest of the world. The Israeli study highlights some of the strengths of the Global Epidemiology Study: the 2 respondents had a geographical spread representative of the country. |
| 29 | Ines A. Trindade, | Global Prevalence of Psychological Distress and Comorbidity With Disorders of Gut-Brain Interactions | 2024 | Trindade, I. A., J. P. Hreinsson, C. Melchior, J. P. Algera, E. Colomier, H. Tornblom, D. Drossman, J. Tack, O. S. Palsson, S. I. Bangdiwala, A. D. Sperber and M. Simren (2024). "Global Prevalence of Psychological Distress and Comorbidity With Disorders of Gut-Brain Interactions." Am J Gastroenterol 119(1): 165-175. | https://www.ncbi.nlm.nih.gov/pubmed/37721510 | This study focused on defining the global prevalence of clinically relevant levels of psychological distress and somatic symptoms and the prevalence of coexistence between these symptoms and disorders of gut-brain interaction (DGBI). We also analyzed how clinically relevant psychological distress and somatic symptoms and coexistent DGBI are associated with health-related outcomes. METHODS: We included a representative sample of 54,127 adult participants (49.1% women; mean age of 44.3 years) from 26 countries worldwide. Participants completed an Internet survey (the Rome Foundation Global Epidemiology Study) with validated self-report questionnaires. RESULTS: Clinically relevant psychological distress and/or somatic symptom severity was reported by 37.5% of the sample. These participants had 4.45 times higher odds to have at least one DGBI than individuals without psychological distress and/or somatic symptoms. Compared with participants with psychological distress and/or somatic symptomswith vswithout DGBI, participantswith aDGBI reported increased healthcare and medication utilization (withORfrom 1.6 to2.8). CoexistentDGBI in participants with psychological distress and/or somatic symptoms was the variable most strongly associated with reduced mental (b520.77; confidence interval [20.86 to20.68]) and physical (b521.17; confidence interval [21.24 to21.10]) quality of life. | This study focused on defining the global prevalence of clinically relevant levels of psychological distress and somatic symptoms and the prevalence of coexistence between these symptoms and disorders of gut-brain interaction (DGBI). We also analyzed how clinically relevant psychological distress and somatic symptoms and coexistent DGBI are associated with health-related outcomes. | This global study shows that psychological distress, somatic symptoms, and DGBI are very common and frequently overlap. The coexistence between psychological distress/somatic symptoms and DGBI seems to be especially detrimental to quality of life and healthcare utilization. Individuals with psychological distress/somatic symptoms and DGBI coexistence seem to be a group vulnerable to psychosocial problems that should be studied further and would likely benefit from psychological/ psychiatric interventions. |
| 30 | Ami D. Sperber | Highlights of the Findings From the Rome Foundation Global Epidemiology Study | 2023 | Sperber, A. D. (2023). "Highlights of the Findings From the Rome Foundation Global Epidemiology Study." Gastroenterol Hepatol (N Y) 19(9): 564-567. | https://www.ncbi.nlm.nih.gov/pubmed/37771792 | Interview with Dr. Sperber: Highlights of the Findings From the Rome Foundation Global Epidemiology Study | ||
| 31 | Olafur S. Palsson | Worldwide population prevalence and impact of sub-diagnostic gastrointestinal symptoms | 2024 | Palsson, O. S., J. Tack, D. A. Drossman, B. Le Neve, L. Quinquis, R. Hassouna, J. Ruddy, C. B. Morris, A. D. Sperber, S. I. Bangdiwala and M. Simren (2024). "Worldwide population prevalence and impact of sub-diagnostic gastrointestinal symptoms." Aliment Pharmacol Ther 59(7): 852-864. | https://www.ncbi.nlm.nih.gov/pubmed/38311841 | Background: The Rome Foundation Global Epidemiology Study (RFGES) found that 40.3% of adults in 26 internet-surveyed countries met Rome IV criteria for disorders of gut–brain interaction (DGBI). However, additional people not meeting DGBI criteria may also be burdened by frequent gastrointestinal symptoms. Aims: To explore the prevalence and demographic distribution of sub-diagnostic gastrointestinal symptoms, and the hypothesised associated effects on quality of life (QoL), life functioning and healthcare needs. Methods: We analyzed data from the RFGES survey, which included the Rome IV diagnostic questionnaire and QoL, psychological, work productivity and healthcare questions. Results: Of the 50,033 people without a history of organic gastrointestinal disorders, 25.3% classified in the sub-diagnostic group (no DGBI but one or more frequent gastrointestinal symptoms), 41.4% had DGBI and 33.4% had no frequent gastrointestinal symptoms (non-GI group). Sub-diagnostic prevalence in different world regions ranged from 22.2% (North America) to 30.5% (Middle East), was slightly higher among males than females and decreased with age. The sub-diagnostic group was intermediate between the non-GI and DGBI groups, and significantly different from both of them on QoL, anxiety, depression, somatisation, healthcare utilisation and life and work impairment. Conclusions: One in four adults without organic gastrointestinal disorders or DGBI report frequent gastrointestinal symptoms. This sub-diagnostic group has reduced QoL, greater psychological and non-GI bodily symptoms, impaired work productivity and life activities and greater healthcare use compared to non-GI individuals. This suggests that many in this sub-diagnostic group might benefit from healthcare services or symptom self-management advice. | To explore the prevalence and demographic distribution of sub-diagnostic gastrointestinal symptoms, and the hypothesised associated effects on quality of life | One in four adults without organic gastrointestinal disorders or DGBI report frequent gastrointestinal symptoms. This sub-diagnostic group has reduced QoL, greater psychological and non-GI bodily symptoms, impaired work productivity and life activities and greater healthcare use compared to non-GI individuals. This suggests that many in this sub-diagnostic group might benefit from healthcare services or symptom self-management advice. |
| 32 | Pragalathan Apputhurai | Confirmatory validation of the patient health questionnaire - 4 (PHQ-4) for gastrointestinal disorders: A large-scale cross-sectional survey | 2024 | Apputhurai, P., O. S. Palsson, S. I. Bangdiwala, A. D. Sperber, A. Mikocka-Walus and S. R. Knowles (2024). "Confirmatory validation of the patient health questionnaire - 4 (PHQ-4) for gastrointestinal disorders: A large-scale cross-sectional survey." J Psychosom Res 180: 111654. | https://www.ncbi.nlm.nih.gov/pubmed/38569449 | Objective: Using the large Rome Foundation Global Epidemiology Survey dataset, the aim of this study was to "evaluate the construct and convergent validity and internal consistency of the PHQ-4 across both gastrointestinal and non-gastrointestinal condition cohorts. Another aim was to provide descriptive information about the PHQ-4 including means, confidence intervals and percentage of caseness using a large representative sample. Methods: A cross-sectional survey was conducted in 26 countries. Confirmatory factor and internal consistency analyses were conducted across subsamples of patients with gastrointestinal conditions (i.e., disorders of gut- brain interaction [DGBI; any DGBI, individual DGBI, and DGBI region], gastroesophageal reflux disease (GERD), coeliac disease, diverticulitis, inflammatory bowel disease (IBD), cancer anywhere in the gastrointes- tinal tract, peptic ulcer) and those without a gastrointestinal condition. Convergent validity was also assessed via a series of Pearson's correlation coefficients with PROMIS (physical and mental quality of life), and PHQ-12 (somatisation). Results: Based on 54,127 participants (50.9% male; mean age 44.34 years) confirmatory factor analysis indicated acceptable to excellent model fits for the PHQ-4 across all subsamples and individual DGBI and DGBI region (Comparative Fit Index >0.950, Tucker-Lewis Index >0.950, Root Mean Squared Error of Approximation <0.05, and Standardised Root Mean Square Residual <0.05). The PHQ-4 was found to demonstrate convergent validity (Pearson's correlation coefficients >±0.4), and good internal consistency (Cronbach's α > 0.75). Conclusions: This study provides evidence that the PHQ-4 is a valid and reliable tool for assessing mental health symptomology in both gastrointestinal and non-gastrointestinal cohorts." | We evaluated the construct and convergent validity and internal consistency of the PHQ-4 across both gastrointestinal and non-gastrointestinal condition cohorts. | This study provides evidence that the PHQ-4 is a valid and reliable tool for assessing mental health symptomology in both gastrointestinal and non-gastrointestinal cohorts." |
| 33 | Christopher J. Black | Novel Irritable Bowel Syndrome Subgroups are Reproducible in the Global Adult Population | 2024 | Black, C. J., L. A. Houghton, R. M. West, S. I. Bangdiwala, O. S. Palsson, A. D. Sperber and A. C. Ford (2024). "Novel Irritable Bowel Syndrome Subgroups are Reproducible in the Global Adult Population." Clin Gastroenterol Hepatol. | https://www.ncbi.nlm.nih.gov/pubmed/38876193 | BACKGROUND & AIMS: Current classification systems for irritable bowel syndrome (IBS) based on bowel habit do not consider psychological impact. We validated a classification model in a UK population with confirmed IBS, using latent class analysis, incorporating psychological factors. We applied this model in the Rome Foundation Global Epidemiological Survey (RFGES), assessing impact of IBS on the individual and the health care system, and examining reproducibility. METHODS: We applied our model to 2195 individuals in the RFGES with Rome IV–defined IBS. As described previously, we identified 7 clusters, based on gastrointestinal symptom severity and psychological burden. We assessed demographics, health care–seeking, symptom severity, and quality of life in each. We also used the RFGES to derive a new model, examining whether the broader concepts of our original model were replicated, in terms of breakdown and characteristics of identified clusters. RESULTS: All 7 clusters were identified. Those in clusters with highest psychological burden, and particularly cluster 6 with high overall gastrointestinal symptom severity, were more often female, exhibited higher levels of health care–seeking, were more likely to have undergone previous abdominal surgeries, and had higher symptom severity and lower quality of life | We validated a classification model in a UK population with confirmed IBS, using latent class analysis, incorporating psychological factors. | All 7 clusters were identified. Those in clusters with highest psychological burden, and particularly cluster 6 with high overall gastrointestinal symptom severity, were more often female, exhibited higher levels of health care–seeking, were more likely to have undergone previous abdominal surgeries, and had higher symptom severity and lower quality of life |
| 34 | Ami D. Sperber | The aging gastrointestinal tract: Epidemiology and clinical significance of disorders of gut-brain interaction in the older general population | 2024 | Sperber, A. D., T. Freud, O. S. Palsson, S. I. Bangdiwala and M. Simren (2024). "The aging gastrointestinal tract: Epidemiology and clinical significance of disorders of gut-brain interaction in the older general population." Aliment Pharmacol Ther 60(4): 446-456. | https://www.ncbi.nlm.nih.gov/pubmed/38837277 | Background: Most previous reports on the prevalence of disorders of gut-brain interaction (DGBI) show higher rates in younger individuals. Exceptions are faecal incontinence and functional constipation. Aim: To compare prevalence rates for 22 DGBI and 24 primary symptoms, by age, using theRome Foundation Global Epidemiology (RFGES) study dataset. Methods: The RFGES dataset enables diagnosis of 22 DGBI among 54,127 participants (≥18 years) in26 countries. Older age was de"ned as ≥65 years. We assessed di#erences between age groups by sex, geographic region, somatisation, abnormal anxiety and depression scores, quality of life (QoL), individual gastrointestinal symptoms and disease severity for irritable bowel syndrome (IBS). Results: Rates for any DGBI were 41.9% and 31.9% in the <65 and ≥65 age groups, respectively. For all Rome IV diagnoses except faecal incontinence, rates were higher in the younger group. The older group had lower scores for any DGBI by geographic region, non-gastrointestinal somatic symptoms, abnormal anxiety and depression scores, and IBS severity, and better scores for QoL. The mean number of endorsed symptoms and their frequency were higher in the younger group. Conclusions: In this large general population study, the prevalence and impact of DGBI, apart from faecal incontinence, were higher in the younger group. Despite this, DGBI rates are still high in absolute terms in the ≥65 age group and necessitate clinical awareness and, perhaps, an age-specific treatment approach. | We compared prevalence rates for 22 DGBI and 24 primary symptoms, by age | In this large general population study, the prevalence and impact of DGBI, apart from faecal incontinence, were higher in the younger group. Despite this, DGBI rates are still high in absolute terms in the ≥65 age group and necessitate clinical awareness and, perhaps, an age-specific treatment approach. |
| 35 | Tom van Gils | Symptom pro!les compatible with disorders of gut-brain interaction (DGBI) in organic gastrointestinal diseases: A global population-based study | 2024 | van Gils, T., J. P. Hreinsson, H. Tornblom, J. Tack, S. I. Bangdiwala, O. S. Palsson, A. D. Sperber and M. Simren (2024). "Symptom profiles compatible with disorders of gut-brain interaction (DGBI) in organic gastrointestinal diseases: A global population-based study." United European Gastroenterol J 12(7): 834-847. | https://www.ncbi.nlm.nih.gov/pubmed/38975964 | Background: Patients with organic gastrointestinal (GI) diseases and diabetes mellitus (DM) can have concomitant disorders of gut-brain interaction (DGBI). Objective: This study aimed to compare the global prevalence of DGBI-compatible symptom pro"les in adults with and without self-reported organic GI diseases or DM. Methods: Data were collected in a population-based internet survey in 26 countries, the Rome Foundation Global Epidemiology Study (n = 54,127). Individuals were asked if they had been diagnosed by a doctor with gastroesophageal re#ux disease, peptic ulcer, coeliac disease, in#ammatory bowel disease (IBD), diverticulitis, GI cancer or DM. Individuals not reporting the organic diagnosis of interest were included in the reference group. DGBI-compatible symptom pro"les were based on Rome IV diagnostic questions. Odds ratios (ORs [95% confidence interval]) were calculated using mixed logistic regression models. Results: Having one of the investigated organic GI diseases was linked to having any DGBIcompatible symptom pro"le ranging from OR 1.64 [1.33, 2.02] in GI cancer to OR 3.22 [2.80, 3.69] in IBD. Those associations were stronger than for DM, OR 1.26 [1.18, 1.35]. Strong links between organic GI diseases and DGBI-compatible symptom pro"les were seen for corresponding (e.g., IBD and bowel DGBI) and non-corresponding (e.g., IBD and esophageal DGBI) anatomical regions. The strongest link was seen between fecal incontinence and coeliac disease, OR 6.94 [4.95, 9.73]. After adjusting for confounding factors, associations diminished, but persisted. Conclusion: DGBI-compatible symptom pro"les are more common in individuals with self-reported organic GI diseases and DM compared to the general population. The presence of these concomitant DGBIs should be considered in the management of organic (GI) diseases. | This study aimed to compare the global prevalence of DGBI-compatible symptom profiles in adults with and without self-reported organic GI diseases or DM. | DGBI-compatible symptom pro"les are more common in individuals with self-reported organic GI diseases and DM compared to the general population. The presence of these concomitant DGBIs should be considered in the management of organic (GI) diseases. |
| 36 | Thomas Fairlie | A multifaceted ecological approach to explore links between environmental factors and the epidemiology of disorders of gut–brain interaction | 2024 | Fairlie, T., A. Shah, R. K. Wong, X. Fang, U. C. Ghoshal, P. C. Kashyap, A. Mulak, Y. Y. Lee, A. D. Sperber, N. Koloski, N. Moy, N. J. Talley, M. P. Jones and G. Holtmann (2024). "A multifaceted ecological approach to explore links between environmental factors and the epidemiology of disorders of gut-brain interaction." Neurogastroenterol Motil 36(9): e14866. | https://www.ncbi.nlm.nih.gov/pubmed/39005136 | Background: Disorders of gut–brain interaction (DGBI) are characterized by debilitating symptoms not explained by structural or biochemical abnormalities. While functional conditions present with complex, likely heterogeneous pathophysiology, we aimed to investigate if proxy measures of sociocultural and environmental factors are associated with the prevalence of various DGBI in populations across the world. Methods: We performed an ecological study utilizing peer-reviewed published datasets reporting for 26 countries prevalence rates of DGBI (Rome Foundation Global Epidemiology Study, RFGES), with six independent variables: Helicobacter pylori prevalence and household size as proxy measures for orofecal infections, gross domestic product per capita (GDP), and median age as a proxy measures for socioeconomic development, density of fast food outlets (FFO) per 100,000 population as proxy measure for processed food exposure, and suicide mortality rate per 100,000 people, and world happiness scores were used as a proxy for psychological stress. The data were retrieved from publicly accessible datasets (United Nations, CIA World Factbook, World Bank, World Happiness Report, commercial/financial reports of a global FFO chain). We used linear regression to assess variables in univariate and multivariate analysis and report standardized β coefficients with 95% confidence intervals (CI). Key Results: The regression model revealed that the overall prevalence of DGBI was inversely associated with both GDP per capita (β = −0.57, 95% CI: −0.92, −0.22, p = 0.002) and happiness scores (β = −0.433 95% CI: 0.821, −0.065, p = 0.023), while being positively associated with H. pylori prevalence (β = 0.40, 95% CI: 0.008, 0.81,p = 0.046). The prevalence of functional constipation (FC) was also inversely associated with GDP per capita (β = −0.50, 95% CI: −0.86, −0.13, p = 0.01) and happiness scores (β = −0.497, 95% CI: −0.863, −0.132, p = 0.01), while being positively associated with H. pylori prevalence (β = 0.53, 95% CI: 0.16, 0.91, p = 0.007). The Multivariate model analysis revealed that combining the factors of H. pylori prevalence, suicide rate, household size and happiness scores showed statistically significant association with FC (p = 0.039). Household size (β = −0.43, 95% CI: −0.82, 0.038, p = 0.033) and suicide rates (β = 0.55, 95% CI: 0.19, 0.90, p = 0.004) were statistically significantly associated with functional diarrhea. Irritable bowel syndrome (IBS) was associated with GDP per capita (β = −0.40, 95% CI: −0.79, −0.014, p = 0.043) and happiness scores (β = −0.390, 95% CI: −0.778, −0.003, p = 0.049). Conclusions & Inferences: Utilizing publicly available data, the prevalence of DGBI across diverse countries is linked to various socio-cultural and environmental factors. Collectively, the data suggests that the prevalence of DGBI is increased in less prosperous regions of the world. | We aimed to investigate if proxy measures of sociocultural and environmental factors are associated with the prevalence of various DGBI in populations across the world. | Utilizing publicly available data, the prevalence of DGBI across diverse countries is linked to various socio-cultural and environmental factors. Collectively, the data suggests that the prevalence of DGBI is increased in less prosperous regions of the world. |
| 37 | Helen Burton-Murray | Pain is a cardinal symptom cutting across Rome IV anatomical categories in disorders of gut-brain interaction: A network-based approach | 2024 | Burton-Murray, H., L. Guadagnoli, I. A. Vanzhula, T. A. Brown, A. D. Sperber, O. Palsson, S. I. Bangdiwala, L. Van Oudenhove and K. Staller (2024). "Pain is a cardinal symptom cutting across Rome IV anatomical categories in disorders of gut-brain interaction: A network-based approach." Neurogastroenterol Motil 36(10): e14877. | https://www.ncbi.nlm.nih.gov/pubmed/39077969 | Introduction: Disorders of gut-brain interaction (DGBI) are symptom-based disorders categorized by anatomic location but have high overlap and heterogeneity. Viewing DGBI symptoms on a spectrum (i.e. dimensionally) rather than categorically may better inform interventions to accommodate complex clinical presentations. We aimed to evaluate symptom networks to identify how DGBI symptoms interact. Methods: We used the Rome IV Diagnostic Questionnaire continuously/ordinally scored items collected from the Rome Foundation Global Epidemiology Study. We excluded participants who reported ≥1 organic/structural gastrointestinal disorder(s). We sought to (1) identify core symptoms in the DGBI symptom networks, (2) identify bridge pathways between Rome IV diagnostic categories (esophageal, bowel, gastroduodenal, anorectal), and (3) explore how symptoms group together into communities.Results: Of 54,127 adults, 20,229 met criteria for at least one DGBI (age mean = 42.2 ± 15.5; 57% female). General abdominal pain and epigastric pain were the core symptoms in the DGBI symptom network (i.e., had the strongest connections to other symptoms). Pain symptoms emerged as bridge pathways across existing DGBI diagnostic anatomic location (i.e., abdominal pain connected to chest pain, epigastric pain, rectal pain). Without a priori category definitions, exploratory network community analysis showed that symptoms grouped together into "pain," "gastroduodenal," and "constipation," rather than into groups by anatomic location. Conclusion: Our findings suggest pain symptoms are central and serve as a key connection to other symptoms, crosscutting anatomic location. Future longitudinal research is needed to test symptom network relations longitudinally and investigate whether targeting pain symptoms (rather than anatomic-or disorder-specific symptoms) has clinical impact. | We aimed to evaluate symptom networks to identify how DGBI symptoms interact. | Our findings suggest pain symptoms are central and serve as a key connection to other symptoms, crosscutting anatomic location. Future longitudinal research is needed to test symptom network relations longitudinally and investigate whether targeting pain symptoms (rather than anatomic-or disorder-specific symptoms) has clinical impact. |
| 38 | Arantzazu Izagirre | Worldwide Prevalence and Description of Cyclic Vomiting Syndrome According to the Results of the Rome Foundation Global Epidemiology Study | 2024 | Izagirre, A., C. Sarasqueta, J. Flores-Arriaga, M. C. Aso, M. Perez Perez, J. Tack, I. H. Huang, A. D. Sperber, O. S. Palsson, S. I. Bangdiwala, M. D'Amato, A. Lanas, B. Lobo, C. Alonso-Cotoner, J. Santos and L. Bujanda (2024). "Worldwide Prevalence and Description of Cyclic Vomiting Syndrome According to the Results of the Rome Foundation Global Epidemiology Study." Am J Gastroenterol. | https://www.ncbi.nlm.nih.gov/pubmed/39319824 | Background & Aims: Cyclic vomiting syndrome (CVS) is a disorder of gut-brain interaction (DGBI) of unknown origin. This study aimed to evaluate the global prevalence of this disorder and its associated factors. Methods: Data were collected from nationwide Internet surveys in 26 countries, with subjects evenly distributed by age, sex and country. The survey included the Rome IV questionnaire as well as an extensive supplemental questionnaire to evaluate additional factors. Results: 54,127 participants completed the questionnaire (51% male, mean age 44.3 years). The pooled prevalence of CVS was 0.3% (95% CI 0.3-0.4%; n=187), highest in Brazil (1%, 95% CI 0.6-1.5), and lowest in Japan and Germany (with no subject who fulfilled the criteria for CVS). The mean age of participants with CVS was 36.7 years (standard deviation 13.5) and it was more common in females (56.7% vs 43.5%). Factors independently associated with this syndrome were female sex (OR 1.52, 95% CI 1.13- 2.03), young age (OR 2.57, 95% CI 1.34-4.94, for people between the ages of 18 and 39 years, compared to those older than 65 years), depression (OR 3.14, 95% CI 2.05- 4.82, p<0.001) and anxiety (OR 1.79, 95% CI 1.15-2.78, p<0.001). Individuals with CVS had impaired quality of life (QoL) (PROMIS-10 score: physical QoL mean, 12.9 vs 15.5, p<0.001; mental QoL mean 12.3 vs 14.4, p<0.001) compared to others. Conclusions: CVS is a relatively common disorder that has a negative impact on quality of life. It is important to raise awareness on this syndrome to avoid underdiagnosis and improve clinical practice. | This study aimed to evaluate the global prevalence of Cyclic vomiting syndrome (CVS) and its associated factors. | CVS is a relatively common disorder that has a negative impact on quality of life. It is important to raise awareness on this syndrome to avoid underdiagnosis and improve clinical practice. |
| 39 | Michael P. Jones | Diagnostic Classification systems for disorders of gut-brain interaction should include psychological symptoms | 2024 | Jones, M. P., G. J. Holtmann, J. Tack, F. Carbonne, W. Chey, N. Koloski, A. Shah, S. I. Bangdiwala, A. D. Sperber, O. S. Palsson and N. J. Talley (2024). "Diagnostic classification systems for disorders of gut-brain interaction should include psychological symptoms." Neurogastroenterol Motil 36(12): e14940. | https://www.ncbi.nlm.nih.gov/pubmed/39450680 | BACKGROUND AND AIMS: The group of disorders known as Disorders of Gut Brain Interaction (DGBI) were originally labeled functional GI disorders and were thought to be disorders of the gastrointestinal tract that had several psychological conditions as comorbidities. Despite mounting evidence that psychological morbidity plays an innate role in the etiology and maintenance of DGBI, none of the Rome IV criteria include any measure of psychological symptoms. This study tested the hypothesis that individuals would cluster differently if GI symptoms alone were considered versus GI symptoms combined with measures of psychological symptoms. METHODS: Data were obtained from the Rome Foundation Global Epidemiology Study measuring Rome IV GI symptoms, psychological measures and demographic characteristics. Latent profile models were used to cluster individuals based on (i) GI symptoms only (GI only) and then (ii) GI and psychological measures (GI + Psych). KEY RESULTS: Individuals clustering into the same group of individuals whether formed via GI only or GI + Psych, ranged from 96% for a 2-class solution (the most simplistic) to 76% with 6 classes (the parsimonious system) and 59% with twenty-two classes (mimicking Rome IV). The generalisability of this finding between six geographic regions was confirmed with agreement varying between 95%-97% for 2 clusters and 71-79% for 6 classes and 51%-63% for 22 classes. These findings were also consistent between DGBI (range 94% with 2 classes to 50% with 22 classes) and non-DGBI (range 97% with 2 clusters to 65% with 22 classes) groups. CONCLUSIONS & INFERENCES: Our data suggest that considering psychological as well as gastrointestinal symptoms would lead to a different clustering of individuals in more complex, and accurate, classification systems. For this reason, future work on DGBI classification should consider inclusion of psychological traits. | This study tested the hypothesis that individuals would cluster differently if GI symptoms alone were considered versus GI symptoms combined with measures of psychological symptoms | Considering psychological as well as gastrointestinal symptoms would lead to a different clustering of individuals in more complex, and accurate, classification systems |