Tu2082 Validation of ROME III Criteria for Irritable Bowel Syndrome in a Primary Care Setting - A Pilot Study

Abstract

Background: According to Rome III diagnostic criteria for Irritable Bowel Syndrome (IBS) subjects required to have at least two of the three symptom criteria: (a) abdominal pain or discomfort relieved/ improved by defecation; (b) onset of pain associated with change of stool form (appearance); (c) onset of pain associated with and/or stool frequency. These criteria have never been validated in a primary care setting. Aim: We aimed to study the association between abdominal pain, defecation, stool consistency and frequency in patients with IBS in a primary care setting. Method: Primary care physicians from 8 Swedish primary care stations included 125 patients with IBS (78 % female, mean age 51 years, SD 13.3) and 89 patients without IBS (72 % female, mean age 51 years, SD 11.5). IBS diagnosis was based on the clinical evaluation of the primary care physician. All subjects recorded their gastrointestinal (GI) symptoms and bowel habits (Bristol Stool Form Chart) prospectively during 14 days on validated paper and pencil diaries. Results: Symptom diaries from 3028 days were available. Altogether IBS patients recorded 3957 hours of abdominal pain and non-IBS controls recorded 686 hours of pain. In IBS pain intensity was light during 36%, moderate during 48% and intense during 9% of the time. 13% of pain episodes in IBS were improved by defecation (within one hour). In IBS patients, the average number of stools on days when pain was reported was 2.2 (SD 1.7) compared to 1.5 stools per day (SD 1.3) when pain was not reported (p,0.001). During days when IBS patients reported abdominal pain they had a significantly higher proportion of stools type Bristol 5, 6 and 7 (Table). Stool consistency distribution for IBS patients was 10% for Bristol stool type 1 (B1), 12% for B2, 11% for B3, 17% for B4, 21% for B5, 15% for B6 and 14% for B7. The respective numbers for non-IBS controls were 5% for B1, 12% for B2, 15% for B3, 31% for B4, 25% for B5, 8% for B6 and 4% for B7. Conclusions: Abdominal pain in IBS was associated with a change of stool form and stool frequency. Only a minority of pain episodes was improved by defecation.