Effects of Rome IV Definitions of Functional Dyspepsia Subgroups in Secondary Care

K Van den Houte, Florencia Carbone, Nick Goelen, Jolien Schol, Imke Masuy, Joris Arts, Philip Caenepeel, Dirk Staessen, Philippe Vergauwe, Guy Van Roey, Pascale Latour, Hubert Piessevaux, Philippe Maldague, Ariane Gerkens, Fabien Wuestenberghs, Alain Vandenberghe, Jan Tack
Clinical Gastroenterology and Hepatology 2020 July 6

BACKGROUND & AIMS: Functional dyspepsia (FD) is subdivided into postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) according to the Rome III consensus. In clinical practice, there is a major overlap between these subgroups. The Rome IV criteria included postprandially occurring symptoms in the PDS subgroup. We aimed to analyze the effects of the Rome IV criteria, compared to Rome III, on FD subgroups in patients recruited from secondary care.

METHODS: Patients with FD (n=224; mean age, 43±1 years; 77% women) were recruited from secondary-care units in Belgium and filled out symptom questionnaires, allowing subdivision according to Rome III and Rome IV criteria and identification of postprandial symptoms. Symptom patterns and demographics were compared between the subgroups. Statistical analysis was performed using the t-test and Fisher's exact test.

RESULTS: According to the Rome III criteria, 25% of participants had PDS, 8% had EPS, and 67% had an overlap. Postprandial fullness, early satiation, and bloating were present in significantly more patients in the PDS and overlap groups than the EPS group (P<.0001). A higher proportion of patients in the overlap group showed symptoms as postprandial epigastric pain and nausea than in the EPS group (both P≤.02). With the Rome IV criteria, the overlap group was reduced to 35%; 57% of patients were considered to have PDS and 8% to have EPS. Postprandial pain was significantly more prevalent in the PDS than in the EPS group (P≤.002), and postprandial nausea was significantly more prevalent in the PDS group than the overlap group (P=.007).

CONCLUSION: Compared to Rome III criteria, the Rome IV criteria significantly reduce the overlap between PDS and EPS groups. Studies are needed to determine if Rome IV subgroups are differently associated with psychological co-morbidities and treatment responses.

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