New Diagnostic Tool Could Improve Treatment of Inflammatory Bowel Conditions

Researchers have amended diagnostic criteria and patient questionnaires for functional gastrointestinal disorders (FGID).

Physicians have to rely heavily on diagnostic material to make a proper diagnosis for patients, since there are no laboratory tests available.

“(If a person has a functional GI disorder), the gut is healthy, but it functions differently,” said Miranda van Tilburg, PhD, contributor of the new diagnostic criteria. “We have to (diagnosis) based on symptoms … You could compare it to a (mental health diagnosis) in a way. For example, you cannot do a blood test for depression. You have to ask people questions and so we have to do the same thing for these disorders.”

As more information is found on these disorders, it is critical that the diagnostic tools be updated.

“The diagnostic criteria for functional GI and some motility disorders have gone through 4 editions, so the one that’s just been released — Rome IV – is being published about 10 years after Rome III,” said researcher William E. Whitehead, PhD. “It tries to incorporate the research that’s been done since that time.”

For the latest diagnostic questionnaire, researchers focused on the adult questionnaire and reworked the answer categories so that they were more sensitive and better at identifying symptoms.

“Our job was, in part, to develop a diagnostic questionnaire based on criteria that committees of experts developed for making these diagnoses,” Whitehead continued. “Developing these materials was a multi-year process to be sure it was understandable and translatable to other languages and that it was valid in the sense that it agrees with the diagnoses of expert clinicians.”

One particular disorder that underwent diagnostic changes was irritable bowel syndrome (IBS), so that physicians could more accurately identify patients who truly suffered from IBS.

“In the adult criteria, (IBS) used to be diagnosed based on the presence of abdominal pain or discomfort at least 3 times a month,” Whitehead said. “The new criteria require that there be pain — so discomfort doesn’t qualify – and it requires that it occur at least once a week on average. There are also some changes in the way that sub-types of IBS are diagnosed, which often dictate what treatment is appropriate – what drugs, especially.”

Between Rome III and Rome IV, the prevalence of IBS in children and adolescents increased from 2.8% to 5%.

New categories added to the criteria in pediatrics included, functional nausea and functional vomiting, and new categories for adults included cannabinoid-induced nausea and opiate-induced constipation.