Functional gastrointestinal disorders in eating disorder patients:Altered distribution and predictors using ROME Ⅲ compared to ROME Ⅱ criteria

AIM:To compare the prevalence of Functional gastrointestinal disorders(FGIDs)using ROMEⅢand ROMEⅡand to describe predictors of FGIDs among eating disorder(ED)patients.METHODS:Two similar cohorts of female ED inpatients,aged 17-50 years,with no organic gastrointestinal or systemic disorders,completed either the ROMEⅢ(n=100)or the ROMEⅡ(n=160)questionnaire on admission for ED treatment.The two ROME cohorts were compared on continuous demographic variables(e.g.,age,BMI)using Student’s t-tests,and on categorical variables(e.g.,ED diagnosis)usingχ2-tests.The relationship between ED diagnostic subtypes and FGID categories was explored usingχ2-tests.Age,BMI,and psychological and behavioural predictors of the common(prevalence greater than 20%)ROMEⅢFGIDs were tested using logistic regression analyses.RESULTS:The criteria for at least one FGID were fulfilled by 83%of the ROMEⅢcohort,and 94%of the ROMEⅡcohort.There were no significant differences in age,BMI,lowest ever BMI,ED diagnostic subtypes or ED-related quality of life(QOL)scores between ROMEⅡand ROMEⅢcohorts.The most prevalent FGIDs using ROMEⅢwere postprandial distress syndrome(PDS)(45%)and irritable bowel syndrome(IBS)(41%),followed by unspecified functional bowel disorders(U-FBD)(24%),and functional heartburn(FH)(22%).There was a 29%or 46%increase(depending on presence or absence of cyclic vomiting)in functional gastroduodenal disorders because of the introduction of PDS in ROMEⅢcompared to ROMEⅡ.There was a 35%decrease in functional bowel disorders(FBD)in RomeⅢ(excluding U-FBD)compared to ROMEⅡ.The most significant predictor of PDS was starvation(P=0.008).The predictor of FH(P=0.021)and U-FBD(P=0.007)was somatisation,and of IBS laxative use(P=0.025).Age and BMI were not significant predictors.The addition of the 6-mo duration of symptoms requirement for a diagnosis in ROMEⅢadded precision to many FGIDs.CONCLUSION:ROMEⅢconfers higher precision in diagnosing FGIDs but self-induced vomiting should be excluded from the diagnosis of cyclic vomiting.Psychological factors appear to be more influential in ROMEⅡthan ROMEⅢ.