Symptom Patterns Outside the Rome IV Consensus in Eastern and Western Patients With a Disorder of Gut-Brain Interaction

INTRODUCTION: The diagnostic Rome criteria, classify disorders of gut-brain interaction (DGBI) according to the anatomical region of the gastrointestinal (GI) tract from which the predominant symptom are perceived to originate. A study in Asian DGBI patients using an Enhanced Asian Rome questionnaire (EAR3Q) identified symptom clusters involving multiple anatomical section. Our aim was to investigate if DGBI symptom groupings involving more than 1 anatomical region can be found in both Eastern and Western DGBI patients.

METHODS: Physician-diagnosed DGBI patients, recruited from 5 Eastern and 6 Western, completed the EAR4Q. We performed an exploratory and confirmatory factor analysis on questionnaire data to identify symptom groupings, describing distinct DGBI diagnostic entities.

RESULTS: In total, 1,074 DGBI patients (66.8% women, 42.6 ± 14.6 years) were recruited. We identified 10 distinct symptom groupings: (i) irritable bowel syndrome predominant diarrhea triggered by a meal and relieved by bowel movement or passing of flatus; (ii) constipation; (iii) upper GI symptoms with predominant regurgitation, nausea and vomiting; (iv) upper and lower GI symptoms relieved by bowel movement or flatus; (v) epigastric pain or burning related to bowel movement or passing flatus; (vi) lower GI symptoms triggered or worsened by bowel movement or passing flatus; (vii) meal-related pain and gas symptoms; (viii) globus and dysphagia; (ix) functional chest pain and heartburn; (x) constipation and belching relieved by bowel movement or passing flatus. Although some symptom groupings aligned with the Rome IV diagnostics, several clearly include multiple anatomical regions, surpassing the scope of the Rome regional subdivision approach.

CONCLUSION: Our study revealed 10 distinct symptom clusters. Some aligned with Rome criteria but other extended beyond its strict anatomical divisions, challenging a key assumption of the Rome classification framework. These results provide novel insight on a multicontinental scale about the complexity of symptom patterns in DGBI and their anatomical relationships.