본문 바로가기
KERD
논문KCI 등재

Epidemiology of Disorders of the Gut-Brain Interaction: An Appraisal of the Rome IV Criteria and Beyond

Ray Gautam|Ghoshal Uday Chand
거트앤리버 소화기연관학회협의회|2024.07|Gut and Liver|제18권 제4호|pp. 578-592|DOI 10.5009/gnl230396

2

조회

0

다운로드

0

인용

0

참고문헌

키워드

EpidemiologyDiagnostic criteriaIrritable bowel syndromefunctionalGut-brain axisGastrointestinal disorders

초록

Disorders of the gut-brain interaction (DGBIs) are presently classified into mutually exclusive anatomical area-related symptom-based categories according to the Rome IV criteria. The pathophysiology of visceral nociception, which contributes to the wide range of symptoms of DGBIs, involves complex psychobiological processes arising from the bidirectional interactions of multiple systems at the gut and brain levels, which affect symptom expression and illness behaviors. The attitude toward an illness and expression of pain and bowel habit vary across cultures with variable interpretation based on sociocultural beliefs, which may not tally with the medical definitions. Thus, psychological factors impact DGBI definitions, their severity and health care utilization. Due to the poor localization and multisegment referral of visceral pain, the anatomical site of pain may not correspond to the affected segment, and there may be a variable degree of overlap among symptoms. The somewhat restrictively defined Rome IV criteria assume one-to-one correlation of symptoms with underlying pathophysiology and ignore overlapping DGBIs, nonstandardized symptom categories, and change or shift in category over time. The microorganic nature of DGBIs resulting from systemic, metabolic or motility disorders, gut dysbiosis and inflammation are not addressed in the Rome IV criteria. Although there is a multidimensional clinical profile that does address these factors, it is not followed rigorously in practice. Threshold changes for diagnostic criteria or addition/deletion of symptoms leads to wide variation among different DGBI criteria resulting in uncertain comparability of results. Although the Rome IV criteria are excellent for research studies and therapeutic trials in homogenous populations, further improvement is needed for their wider applicability in clinical practice.

Abstract

Disorders of the gut-brain interaction (DGBIs) are presently classified into mutually exclusive anatomical area-related symptom-based categories according to the Rome IV criteria. The pathophysiology of visceral nociception, which contributes to the wide range of symptoms of DGBIs, involves complex psychobiological processes arising from the bidirectional interactions of multiple systems at the gut and brain levels, which affect symptom expression and illness behaviors. The attitude toward an illness and expression of pain and bowel habit vary across cultures with variable interpretation based on sociocultural beliefs, which may not tally with the medical definitions. Thus, psychological factors impact DGBI definitions, their severity and health care utilization. Due to the poor localization and multisegment referral of visceral pain, the anatomical site of pain may not correspond to the affected segment, and there may be a variable degree of overlap among symptoms. The somewhat restrictively defined Rome IV criteria assume one-to-one correlation of symptoms with underlying pathophysiology and ignore overlapping DGBIs, nonstandardized symptom categories, and change or shift in category over time. The microorganic nature of DGBIs resulting from systemic, metabolic or motility disorders, gut dysbiosis and inflammation are not addressed in the Rome IV criteria. Although there is a multidimensional clinical profile that does address these factors, it is not followed rigorously in practice. Threshold changes for diagnostic criteria or addition/deletion of symptoms leads to wide variation among different DGBI criteria resulting in uncertain comparability of results. Although the Rome IV criteria are excellent for research studies and therapeutic trials in homogenous populations, further improvement is needed for their wider applicability in clinical practice.

참고문헌 (84)

  1. Schmulson MJ, "What is new in Rome IV", J Neurogastroenterol Motil, 23, pp.151~163 (2017)
  2. Vanner S, "Fundamentals of neurogastroenterology : basic science", Gastroenterology, 150, pp.1280~1291 (2016)
  3. Siah KT, "Chronic constipation and constipation-predominant IBS : separate and distinct disorders or a spectrum of disease?", Gastroenterol Hepatol(N Y), 12, pp.171~178 (2016)
  4. Moudgal R, "Systemic disease associations with disorders of gut-brain interaction and gastrointestinal transit : a review", Clin Exp Gastroenterol, 14, pp.249~257 (2021)
  5. Wu J, "Diagnostic yield of colonoscopy for organic disease in irritable bowel syndrome and its risk factors : a meta-analysis", Neurogastroenterol Motil, 35, pp.e14481~ (2023)
  6. Asghar Z, "Diagnostic yield of colonoscopy in patients with symptoms compatible with Rome IV functional bowel disorders", Clin Gastroenterol Hepatol, 20, pp.334~341 (2022)
  7. Chen SL, "Systematic review with meta-analysis : prompt endoscopy as the initial management strategy for uninvestigated dyspepsia in Asia", Aliment Pharmacol Ther, 41, pp.239~252 (2015)
  8. Hu N, "Epidemiological and clinical features of functional dyspepsia in a region with a high incidence of esophageal cancer in China", Chin Med J(Engl), 134, pp.1422~1430 (2021)
  9. Kaosombatwattana U, "Value of age and alarm features for predicting upper gastrointestinal malignancy in patients with dyspepsia : an endoscopic database review of 4664 patients in Thailand", BMJ Open, 11, pp.e052522~ (2021)
  10. Theunissen F, "The yield of upper gastrointestinal endoscopy in patients below 60 years and without alarm symptoms presenting with dyspepsia", Scand J Gastroenterol, 56, pp.740~746 (2021)
  11. Lorraine-Francis H, "P298 Diagnostic yield of upper gastrointestinal endoscopy in patients with symptoms compatible with functional dyspepsia", Gut, 71(Suppl 1), pp.A184~ (2022)
  12. Oung B, "Endoscopic yield of chronic dyspepsia in outpatients : a single-center experience in Cambodia", JGH Open, 4, pp.61~68 (2019)
  13. Kamiya T, "Questionnaire-based survey on epidemiology of functional gastrointestinal disorders and current status of gastrointestinal motility testing in Asian countries", Digestion, 102, pp.73~89 (2020)
  14. Van Oudenhove L, "Biopsychosocial aspects of functional gastrointestinal disorders : how central and environmental processes contribute to the development and expression of functional gastrointestinal disorders", Gastroenterology, 150, pp.1355~1367 (2016)
  15. Choung RS, "The natural history of chronic unexplained gastrointestinal disorders and gastroesophageal reflux during 20 years : a US population-based study", Mayo Clin Proc, 96, pp.563~576 (2021)
  16. Oshima T, "Epidemiology of functional gastrointestinal disorders in Japan and in the world", J Neurogastroenterol Motil, 21, pp.320~329 (2015)
  17. Goodoory VC, "Characteristics of, and natural history among, individuals with Rome IV functional bowel disorders", Neurogastroenterol Motil, 34, pp.e14268~ (2022)
  18. Aziz Q, "Esophageal disorders", Gastroenterology, 150, pp.1368~1379 (2016)
  19. Sperber AD, "Worldwide prevalence and burden of functional gastrointestinal disorders, results of Rome foundation global study", Gastroenterology, 160, pp.99~114 (2021)
  20. Nirwan JS, "Global prevalence and risk factors of gastro-oesophageal reflux disease(GORD) : systematic review with meta-analysis", Sci Rep, 10, pp.5814~ (2020)
  21. Stanghellini V, "Gastroduodenal disorders", Gastroenterology, 150, pp.1380~1392 (2016)
  22. Barberio B, "Systematic review with meta-analysis : global prevalence of uninvestigated dyspepsia according to the Rome criteria", Aliment Pharmacol Ther, 52, pp.762~773 (2020)
  23. Parkman HP, "Constipation in patients with symptoms of gastroparesis : analysis of symptoms and gastrointestinal transit", Clin Gastroenterol Hepatol, 20, pp.546~558 (2022)
  24. Hooi JKY, "Global prevalence of Helicobacter pylori infection : systematic review and metaanalysis", Gastroenterology, 153, pp.420~429 (2017)
  25. Rahman MM, "Functional dyspepsia, peptic ulcer, and Helicobacter pylori infection in a rural community of South Asia : an endoscopy-assisted household survey", Clin Transl Gastroenterol, 12, pp.e00334~ (2021)
  26. Quach DT, "Overlap of gastroesophageal reflux disease and functional dyspepsia and yield of esophagogastroduodenoscopy in patients clinically fulfilling the Rome IV criteria for functional dyspepsia", Front Med(Lausanne), 9, pp.910929~ (2022)
  27. Van den Houte K, "Effects of Rome IV definitions of functional dyspepsia subgroups in secondary care", Clin Gastroenterol Hepatol, 19, pp.1620~1626 (2021)
  28. Chen Y, "Regional brain activity during rest and gastric water load in subtypes of functional dyspepsia : a preliminary brain functional magnetic resonance imaging study", J Neurogastroenterol Motil, 24, pp.268~279 (2018)
  29. Barberio B, "Derivation and validation of a novel method to subgroup patients with functional dyspepsia : beyond upper gastrointestinal symptoms", Aliment Pharmacol Ther, 53, pp.253~264 (2021)
  30. Oka P, "Global prevalence of irritable bowel syndrome according to Rome III or IV criteria : a systematic review and metaanalysis", Lancet Gastroenterol Hepatol, 5, pp.908~917 (2020)
  31. Chuah KH, "The epidemiology and quality of life of functional gastrointestinal disorders according to Rome III vs Rome IV criteria : a cross-sectional study in primary care", J Dig Dis, 22, pp.159~166 (2021)
  32. Palsson OS, "Prevalence of Rome IV functional bowel disorders among adults in the United States, Canada, and the United Kingdom", Gastroenterology, 158, pp.1262~1273 (2020)
  33. Aziz I, "How the change in IBS criteria from Rome III to Rome IV impacts on clinical characteristics and key pathophysiological factors", Am J Gastroenterol, 113, pp.1017~1025 (2018)
  34. Wang B, "What impact do Rome IV criteria have on patients with IBS in China?", Scand J Gastroenterol, 54, pp.1433~1440 (2019)
  35. Bai T, "Comparison of the Rome IV and Rome III criteria for IBS diagnosis : a cross-sectional survey", J Gastroenterol Hepatol, 32, pp.1018~1025 (2017)
  36. Goyal O, "Prevalence, overlap, and risk factors for Rome IV functional gastrointestinal disorders among college students in northern India", Indian J Gastroenterol, 40, pp.144~153 (2021)
  37. Black CJ, "Epidemiological, clinical, and psychological characteristics of individuals with self-reported irritable bowel syndrome based on the Rome IV vs Rome III criteria", Clin Gastroenterol Hepatol, 18, pp.392~398 (2020)
  38. Vork L, "Rome III vs Rome IV criteria for irritable bowel syndrome : a comparison of clinical characteristics in a large cohort study", Neurogastroenterol Motil, 30, pp.e13189~ (2018)
  39. Black CJ, "Comparison of the Rome IV criteria with the Rome III criteria for the diagnosis of irritable bowel syndrome in secondary care", Gut, 70, pp.1110~1116 (2021)
  40. Fang XC, "Are bowel symptoms and psychosocial features different in irritable bowel syndrome patients with abdominal discomfort compared to abdominal pain?", World J Gastroenterol, 28, pp.4861~4874 (2022)
  41. Black CJ, "A novel method to classify and subgroup patients with IBS based on gastrointestinal symptoms and psychological profiles", Am J Gastroenterol, 116, pp.372~381 (2021)
  42. Ghoshal UC, "Postinfection irritable bowel syndrome", Gut Liver, 16, pp.331~340 (2022)
  43. Klem F, "Prevalence, risk factors, and outcomes of irritable bowel syndrome after infectious enteritis : a systematic review and meta-analysis", Gastroenterology, 152, pp.1042~1054 (2017)
  44. Rahman MM, "Long-term gastrointestinal consequences are frequent following sporadic acute infectious diarrhea in a tropical country : a prospective cohort study", Am J Gastroenterol, 113, pp.1363~1375 (2018)
  45. Schol J, "Postinfectious onset in functional dyspepsia is a risk factor for weight loss", J Gastroenterol, 57, pp.156~163 (2022)
  46. Futagami S, "Systematic review with meta-analysis : post-infectious functional dyspepsia", Aliment Pharmacol Ther, 41, pp.177~188 (2015)
  47. Chuah KH, "Small intestinal bacterial overgrowth in various functional gastrointestinal disorders : a case-control study", Dig Dis Sci, 67, pp.3881~3889 (2022)
  48. Gurusamy SR, "Small intestinal bacterial overgrowth in functional dyspepsia : a systematic review and meta-analysis", Am J Gastroenterol, 116, pp.935~942 (2021)
  49. Shah A, "Small intestinal bacterial overgrowth in irritable bowel syndrome : a systematic review and meta-analysis of case-control studies", Am J Gastroenterol, 115, pp.190~201 (2020)
  50. Shah A, "Current and future approaches for diagnosing small intestinal dysbiosis in patients with symptoms of functional dyspepsia", Front Neurosci, 16, pp.830356~ (2022)
  51. Camilleri M, "Gastroparesis", Nat Rev Dis Primers, 4, pp.41~ (2018)
  52. Ghoshal UC, "Post-infection functional gastrointestinal disorders following coronavirus disease-19 : a case-control study", J Gastroenterol Hepatol, 37, pp.489~498 (2022)
  53. Austhof E, "Persisting gastrointestinal symptoms and post-infectious irritable bowel syndrome following SARS-CoV-2 infection : results from the Arizona CoVHORT", Epidemiol Infect, 150, pp.e136~ (2022)
  54. Barbara G, "Rome foundation working team report on post-infection irritable bowel syndrome", Gastroenterology, 156, pp.46~58 (2019)
  55. de Bortoli N, "Gastroesophageal reflux disease, functional dyspepsia and irritable bowel syndrome : common overlapping gastrointestinal disorders", Ann Gastroenterol, 31, pp.639~648 (2018)
  56. Loosen SH, "Overlap between irritable bowel syndrome and common gastrointestinal diagnoses : a retrospective cohort study of 29, 553 outpatients in Germany", BMC Gastroenterol, 22, pp.48~ (2022)
  57. von Wulffen M, "Overlap of irritable bowel syndrome and functional dyspepsia in the clinical setting : prevalence and risk factors", Dig Dis Sci, 64, pp.480~486 (2019)
  58. Choi YJ, "Overlap between irritable bowel syndrome and functional dyspepsia including subtype analyses", J Gastroenterol Hepatol, 32, pp.1553~1561 (2017)
  59. Ghoshal UC, "Frequency and risk factors of functional gastro-intestinal disorders in a rural Indian population", J Gastroenterol Hepatol, 32, pp.378~387 (2017)
  60. Ghoshal UC, "Prevalence and risk factors of gastroesophageal reflux disease in a rural Indian population", Indian J Gastroenterol, 40, pp.56~64 (2021)
  61. Yao X, "The overlap of upper functional gastrointestinal disorders with irritable bowel syndrome in Chinese outpatients : a multicenter study", J Gastroenterol Hepatol, 31, pp.1584~1593 (2016)
  62. Yao X, "The impact of overlapping functional dyspepsia, belching disorders and functional heartburn on anxiety, depression and quality of life of Chinese patients with irritable bowel syndrome", BMC Gastroenterol, 20, pp.209~ (2020)
  63. Lee SW, "Impact of overlapping functional gastrointestinal disorders on the presentation and quality of life of patients with erosive esophagitis and nonerosive reflux disease", Med Princ Pract, 24, pp.491~495 (2015)
  64. Park KS, "Nationwide multicenter study for overlaps of common functional gastrointestinal disorders in Korean patients with constipation", J Neurogastroenterol Motil, 23, pp.569~577 (2017)
  65. Zacharakis G, "Effects of the Rome IV criteria to functional dyspepsia symptoms in Saudi Arabia : epidemiology and clinical practice", Korean J Gastroenterol, 76, pp.304~313 (2020)
  66. Rasmussen S, "Overlap of symptoms of gastroesophageal reflux disease, dyspepsia and irritable bowel syndrome in the general population", Scand J Gastroenterol, 50, pp.162~169 (2015)
  67. Sperber AD, "Greater overlap of Rome IV disorders of gut-brain interactions leads to increased disease severity and poorer quality of life", Clin Gastroenterol Hepatol, 20, pp.e945~e956 (2022)
  68. Bouchoucha M, "Characteristics of patients with overlap functional gastrointestinal disorders", J Gastroenterol Hepatol, 36, pp.2171~2179 (2021)
  69. Dumitrascu DL, "Epidemiology and burden of disorders of gut-brain interaction in Romania : a subgroup analysis of the Rome foundation global epidemiology study", J Gastrointestin Liver Dis, 31, pp.273~282 (2022)
  70. Aziz I, "The prevalence and impact of overlapping Rome IV-diagnosed functional gastrointestinal disorders on somatization, quality of life, and healthcare utilization : a cross-sectional general population study in three countries", Am J Gastroenterol, 113, pp.86~96 (2018)
  71. Aziz I, "Epidemiology, clinical characteristics, and associations for symptom-based Rome IV functional dyspepsia in adults in the USA, Canada, and the UK : a crosssectional population-based study", Lancet Gastroenterol Hepatol, 3, pp.252~262 (2018)
  72. Nakov R, "Prevalence of irritable bowel syndrome, functional dyspepsia and their overlap in Bulgaria : a population-based study", J Gastrointestin Liver Dis, 29, pp.329~338 (2020)
  73. Ivashkin VT, "Pathogenetic approach to the treatment of functional disorders of the gastrointestinal tract and their intersection : results of the Russian observation retrospective program COMFORT", BMC Gastroenterol, 20, pp.2~ (2020)
  74. Berens S, "Patients with multiple functional gastrointestinal disorders(FGIDs)show increased illness severity : a cross-sectional study in a tertiary care FGID specialty clinic", Gastroenterol Res Pract, 2020, pp.9086340~ (2020)
  75. Gwee KA, "Asia-Pacific guidelines for managing functional dyspepsia overlapping with other gastrointestinal symptoms", J Gastroenterol Hepatol, 38, pp.197~209 (2023)
  76. Koloski NA, "Sleep disturbances in the irritable bowel syndrome and functional dyspepsia are independent of psychological distress : a population-based study of 1322 Australians", Aliment Pharmacol Ther, 54, pp.627~636 (2021)
  77. Hu C, "Cortical morphometry alterations in brain regions involved in emotional, motor-control and self-referential processing in patients with functional constipation", Brain Imaging Behav, 14, pp.1899~1907 (2020)
  78. Zhang Z, "Functional constipation is associated with alterations in thalamo-limbic", parietal structural connectivity, 2021, pp.33, e13992~
  79. Jia Z, "Brain structural changes in regions within the salience network in patients with functional constipation", Brain Imaging Behav, 16, pp.1741~1748 (2022)
  80. Ghoshal UC, "Patients with specific gastrointestinal motility disorders are commonly diagnosed as functional GI disorders in the early stage by community physicians due to lack of awareness", Turk J Gastroenterol, 32, pp.336~348 (2021)
  81. Siah KT, "Rome Foundation-Asian working team report : Asian functional gastrointestinal disorder symptom clusters", Gut, 67, pp.1071~1077 (2018)
  82. Chuah KH, "Cultural factors influencing functional gastrointestinal disorders in the east", J Neurogastroenterol Motil, 24, pp.536~543 (2018)
  83. Wei L, "Gut microbiota dysbiosis in functional gastrointestinal disorders : underpinning the symptoms and pathophysiology", JGH Open, 5, pp.976~987 (2021)
  84. Ghoshal UC, "A meta-analysis on small intestinal bacterial overgrowth in patients with different subtypes of irritable bowel syndrome", J Gastroenterol Hepatol, 35, pp.922~931 (2020)

관련 논문AI추천

로마 기준 IV 이해하기: 로마 기준 IV 개정의 배경류한승, 최석채대한내과학회 · 대한내과학회지2017 · 제92권 제4호로마 기준 IV 이해하기: 과민성 장증후군과 기능성 설사김현정, 김현진, 차라리대한내과학회 · 대한내과학회지2017 · 제92권 제4호Gut Microbiota as Potential Orchestrators of Irritable Bowel SyndromeLena Öhman, Magnus Simrén, Sean M.P. Bennet거트앤리버 소화기연관학회협의회 · Gut and Liver2015 · 제9권 제3호로마 기준 IV 이해하기: 식도 질환박무인대한내과학회 · 대한내과학회지2017 · 제92권 제4호Esophageal Reflux Hypersensitivity: A Comprehensive ReviewFujiwara Yasuhiro, Sawada Akinari, Sifrim Daniel거트앤리버 소화기연관학회협의회 · Gut and Liver2023 · 제17권 제6호Postinfection Irritable Bowel SyndromeGhoshal Uday C거트앤리버 소화기연관학회협의회 · Gut and Liver2022 · 제16권 제3호

이 간행물의 다른 논문 (24건)

From Plate to Stomach: Exploring the Dietary Influence on Gastric Cancer이준행, Kim Tae-Sepp. 551-552Can Epigenetic and Gastric Microbiome Markers Predict the Risk of Helicobacter pylori -Negative Gastric Cancer?Shin Cheol Minpp. 553-555Achieving Sufficient Therapeutic Outcomes of Surgery in Elderly Hepatocellular Carcinoma Patients through Appropriate Selection이한아pp. 556-557Clinical Parameters Work Well as Predictive Factors for Atezolizumab and Bevacizumab Treatment in Hepatocellular CarcinomaSung Pil Soo, Lee Ji Yeonpp. 558-559Challenges and Advancements in Palliative Chemotherapy for Ampullary AdenocarcinomaLee Ji Yeonpp. 560-561
원문 보기