Rome process

The "Rome process" is an international effort to create scientific data to help in the diagnosis and treatment of functional gastrointestinal disorders, (FGIDs), such as irritable bowel syndrome, functional dyspepsia and rumination syndrome. The Rome Diagnostic Criteria are set forth by the Rome Foundation, a not for profit 501(c)(3) organization, under the professional management of Hilliard Associates based in Raleigh, North Carolina.

History

There were systematic approaches that attempted to classify the then hazy area of functional gastrointestinal disorders as early as 1962 when Chaudhary and Truelove published a retrospective review of IBS patients at Oxford, England. Later on, the "Manning Criteria" for irritable bowel syndrome were derived from a paper published in 1978 by Manning and colleagues. This seminal classification started a new era and from then on, scientific work on functional gastrointestinal disorders proceeded with increased enthusiasm.

The Rome criteria have been evolving from the first set of criteria issued in 1989 (The Rome Guidelines for IBS) through the Rome Classification System for FGIDs (1990), or Rome-1, the Rome I Criteria for IBS (1992) and the FGIDs (1994), the Rome II Criteria for IBS (1999) and the FGIDs (1999) to the recent Rome III Criteria (2006). "Rome II" and "Rome III" incorporated pediatric criteria to the consensus.

Process

The Rome criteria are achieved and finally issued through a consensual process, using the Delphi method (or Delphi Technique). The effort is organised by the Rome Coordinating Committee. This process typically takes many months of work by investigators, organized into committees. The committees work by mail and telephone conferences until the final, defining meeting, which takes place in Rome, Italy. The Rome III effort encompassed 87 participants from 18 countries in 14 committees. Members were added from countries outside the more industrialized Western nations; this time there were members from China, Brazil, Chile, Venezuela, Hungary, and Romania. Additional working teams were created to work on issues including: gender, society, patient, and social issues; and pharmacology and pharmacokinetics. Two committees (neonate/toddler and child/adolescent), rather than one, served the pediatrics FGIDs.

Classification

Adult patients

In the Rome III classification, the functional gastrointestinal disorders (FGIDs) are classified into six major domains for adults:

The functional bowel disorders (category C) include: irritable bowel syndrome (C1); functional bloating (C2); functional constipation (C3); functional diarrhea (C4)

Irritable bowel syndrome (C1) is more specifically defined as pain associated with change in bowel habit, which is different from functional diarrhea.

Pediatric patients

The pediatric domains are classified first by age range and then by symptom pattern or area of symptom. Each domain contains several disorders, each with relatively specific clinical features.

Rome Process for Diagnosing IBS

Physicians rely on a variety of procedures and laboratory tests to confirm a diagnosis. The cardinal requirement for the diagnosis of IBS is abdominal pain. The Rome II criteria are used to diagnose IBS after a careful examination of the patient's medical history and physical abdominal examination which looks for any 'red flag' symptoms. More recently, the Rome III criteria, incorporating some changes over the previous set of criteria, have been issued. The Rome II and III efforts have integrated pediatric components in their set of criteria.

According to the Rome II committees and the Functional Brain Gut Research Group,[1] IBS can be diagnosed based on at least 12 weeks, which need not be consecutive, of the preceding 12 months there was abdominal discomfort or pain that had two out of three of these features:[2]

Symptoms that cumulatively support the diagnosis of IBS:

Supportive symptoms of IBS:

Diarrhea-predominant: At least 1 of B, D, F and none of A, C, E; or at least 2 of B, D, F and one of A or E.
Constipation-predominant: At least 1 of A, C, E and none of B, D, F; or at least 2 of A, C, E and one of B, D, F.

Red flag symptoms which are not typical of IBS:

An update to these criteria was issued at the Rome III conference and published in May 2006.[3] The validity of subtypes is called into question:

In addition to meeting these positive criteria, patients have initial laboratory testing with a complete blood count, basic chemistry panel, and an erythrocyte sedimentation rate. Diagnostic accuracy for IBS is over 95% when Rome II criteria are met, history and physical exam do not suggest any other cause, and initial laboratory testing is negative.

In the past it was thought that the diagnosis of IBS relied on a diagnosis of exclusion; that is, if one cannot find a cause then IBS is the diagnosis. Currently the diagnosis of IBS relies on meeting Rome II inclusion criteria (updated by Rome III criteria) and excluding other illnesses based on history, physical exam, and laboratory testing. Although the Rome II and III criteria were not designed to be management guidelines, they are currently a "gold standard" for the diagnosis of IBS. Unfortunately, an IBS diagnosis in an adult patient is still only useful as a tool to rule out more serious problems unless further investigation is employed to discern an addressable condition.

References and sources

  1. ↑ Thompson WG, Longstreth GL, Drossman DA et al. (2000). Functional Bowel Disorders. In: Drossman DA, Corazziari E, Talley NJ et al. (eds.), Rome II: The Functional Gastrointestinal Disorders. Diagnosis, Pathophysiology and Treatment. A Multinational Consensus. Lawrence, KS: Allen Press. ISBN 0-9656837-2-9.
  2. ↑ "Diagnostic Criteria". Irritable Bowel Syndrome Self Help and Support Group. 2005. Retrieved 2005-12-04.
  3. ↑ Longstreth GL, Thompson WG, Chey WD, Houghton LA, Mearin F, and Spiller RC. (2006). Functional Bowel Disorders. Gastroenterology 2006; 130:1480–1491'