Rome III vs Rome IV Criteria for IBS Diagnosis in Southeast Asia - J of JGH - Jan,26

The study published in the *Journal of Gastroenterology and Hepatology* (JGH) on January 26, titled "Rome III vs Rome IV Criteria for IBS Diagnosis in Southeast Asia," investigates how the adoption of the Rome IV diagnostic criteria has impacted the reported prevalence, demographic, and clinical characteristics of irritable bowel syndrome (IBS) in Southeast Asia, specifically in Malaysia and Indonesia.

### Key Findings of the Study:

1. **Prevalence Differences**:

• The Rome IV criteria identified significantly fewer individuals with IBS compared to the Rome III criteria.
• A substantial number of individuals previously diagnosed with IBS under Rome III were reclassified into other functional bowel disorder categories when Rome IV was applied.

2. **Demographic Shifts**:

• IBS cases identified under Rome IV criteria were more likely to be younger and female, suggesting a notable shift in the demographic profile of those diagnosed.
• This indicates that the Rome IV criteria may be more selective in identifying a narrower and more specific subgroup of IBS cases.

3. **Clinical and Psychological Characteristics**:

• Individuals diagnosed with IBS under Rome IV experienced more severe gastrointestinal symptoms compared to those identified under Rome III.
• Despite having more severe symptoms, these individuals reported lower levels of anxiety but poorer mental health-related quality of life.
• This suggests that the Rome IV criteria may capture individuals with greater overall symptom burden and a more pronounced impact on quality of life.

4. **Healthcare Utilization**:

• Patterns of healthcare utilization remained consistent between individuals diagnosed using the Rome III and Rome IV criteria, indicating that the shift in diagnostic criteria does not significantly affect healthcare-seeking behavior.

5. **Dietary Patterns**:

• Participants diagnosed with IBS under the Rome IV criteria followed a more restricted diet, with lower intake across several major food groups.
• This dietary restriction may reflect efforts to manage more severe symptoms or could be a consequence of the narrower diagnostic criteria.

### Implications:

• The reduced sensitivity of the Rome IV criteria for diagnosing IBS in Southeast Asia highlights its limitations in identifying the broader spectrum of IBS cases that were previously captured under Rome III.
• The Rome IV criteria appear to focus on a narrower subset of individuals with more pronounced symptoms and distinct demographic features, potentially underestimating the true prevalence of IBS in the population.
• The findings underscore the importance of considering regional and cultural factors when applying global diagnostic criteria, as dietary habits, healthcare access, and symptom reporting can vary widely across populations.

### Conclusion:

The transition from Rome III to Rome IV criteria has led to a significant reduction in IBS prevalence in Southeast Asia and has shifted the demographic and clinical profile of diagnosed cases. While Rome IV identifies individuals with greater symptom severity and reduced mental well-being, its lower sensitivity may overlook many individuals with milder or atypical forms of IBS. This raises questions about the appropriateness of the Rome IV criteria for diverse populations and highlights the need for region-specific adaptations or complementary diagnostic approaches in Southeast Asia.