Rome Foundation-Asian working team report: Asian functional gastrointestinal disorder symptom clusters

Siah KTH 1 , Gong X 2 , Yang XJ 3 , Whitehead WE 4 , Chen M 5 , Hou X 6 Show all authors , Pratap N 7 , Ghoshal UC 8 , Syam AF 9 , Abdullah M 9 , Choi MG 10 , Bak YT 11 , Lu CL 12 , Gonlachanvit S 13 , Boon CS 14 , Fang F 15 , Cheong PK 15 , Wu JCY 15 , Gwee KA 16

Affiliations 

  • 1 Division of Gastroenterology & Hepatology, University Medicine Cluster, National University Hospital, Singapore
  • 2 Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
  • 3 Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan, USA
  • 4 Centre for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  • 5 Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yet-Sen University, Guangzhou, China
  • 6 Department of Gastroenterology and Hepatology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  • 7 Asian Institute of Gastroenterology, Hyderabad, India
  • 8 Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
  • 9 Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • 10 Department of Internal Medicine, The Catholic University of Korea, Seoul, South Korea
  • 11 Department of Gastroenterology, Korea University Guro Hospital, Seoul, South Korea
  • 12 Division of Gastroenterology, Taipei Veterans General Hospital, National Yang-Ming University Taipei, Taiwan National Yang-Ming University Taipei, Taipei, Taiwan
  • 13 Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
  • 14 Ipoh Gastro Centre, Perak, Malaysia
  • 15 Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Sha Tin, Hong Kong
  • 16 Department of Internal Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Gut, 2018 Jun;67(6):1071-1077.
PMID: 28592440 DOI: 10.1136/gutjnl-2016-312852

Abstract

OBJECTIVE: Functional gastrointestinal disorders (FGIDs) are diagnosed by the presence of a characteristic set of symptoms. However, the current criteria-based diagnostic approach is to some extent subjective and largely derived from observations in English-speaking Western patients. We aimed to identify latent symptom clusters in Asian patients with FGID.

DESIGN: 1805 consecutive unselected patients with FGID who presented for primary or secondary care to 11 centres across Asia completed a cultural and linguistic adaptation of the Rome III Diagnostic Questionnaire that was translated to the local languages. Principal components factor analysis with varimax rotation was used to identify symptom clusters.

RESULTS: Nine symptom clusters were identified, consisting of two oesophageal factors (F6: globus, odynophagia and dysphagia; F9: chest pain and heartburn), two gastroduodenal factors (F5: bloating, fullness, belching and flatulence; F8 regurgitation, nausea and vomiting), three bowel factors (F2: abdominal pain and diarrhoea; F3: meal-related bowel symptoms; F7: upper abdominal pain and constipation) and two anorectal factors (F1: anorectal pain and constipation; F4: diarrhoea, urgency and incontinence).

CONCLUSION: We found that the broad categorisation used both in clinical practice and in the Rome system, that is, broad anatomical divisions, and certain diagnoses with long historical records, that is, IBS with diarrhoea, and chronic constipation, are still valid in our Asian societies. In addition, we found a bowel symptom cluster with meal trigger and a gas cluster that suggests a different emphasis in our populations. Future studies to compare a non-Asian cohort and to match to putative pathophysiology will help to verify our findings.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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