Rome V confirms the prevalence rather than revising it

Design

population-based internet survey using the Rome V diagnostic questionnaire, compared with the earlier Rome IV global study

Population

28,771 adults across 15 countries

Primary outcome

prevalence of disorders of gut-brain interaction under Rome V criteria

Effect

at least one disorder in 40.9% (Rome V) vs 40.5% (Rome IV); functional dyspepsia 8.1%, unclassified bowel disorder 9.6%, chronic constipation 8.9%, IBS 8.5%

The Rome Foundation repeated its global epidemiology survey using the new Rome V criteria, questioning 28,771 adults across 15 countries by internet survey, and compared the result against the Rome IV study. The point of the exercise was validation: new criteria that produced very different prevalence figures would have raised questions about the criteria rather than about the diseases.

They did not. At least one disorder of gut-brain interaction was present in 40.9% of adults under Rome V against 40.5% under Rome IV. Both surveys found higher prevalence in women and a fall with increasing age. Across the 25 conditions in the Rome V set, functional dysphagia was the commonest oesophageal disorder at 4.1%, functional dyspepsia the commonest gastroduodenal one at 8.1%, and unclassified bowel disorder the commonest bowel disorder at 9.6%, ahead of chronic constipation at 8.9% and irritable bowel syndrome at 8.5%. Proctalgia fugax led the anorectal disorders at 7.3%. Two conditions new to Rome V were measured for the first time: abdominal migraine at 5.1% and inability to belch syndrome at 1.4%.

The practical value is the stability. A clinician can now use Rome V criteria without wondering whether the change in definitions has quietly reclassified a large group of patients, and prevalence figures quoted to patients from the Rome IV era remain usable.

Two cautions belong with the numbers. This is an internet survey of self-reported symptoms, so it measures how many people meet symptom criteria, not how many have sought care or need treatment. And the largest single bowel category, at 9.6%, is the unclassified one, which is a reminder that a substantial share of patients will not fit neatly into a named syndrome however carefully the criteria are drawn.

• Use Rome V criteria with confidence that prevalence estimates carry over from Rome IV
• Expect roughly two in five adults in the community to meet criteria for at least one gut-brain disorder, most of whom never present
• Consider abdominal migraine in an adult with recurrent stereotyped abdominal pain and symptom-free intervals, now a named diagnosis
• Recognise inability to belch syndrome as a defined entity rather than dismissing the complaint
• Do not read a community prevalence figure as an indication for treatment; symptom criteria and clinical need are different questions

The statistics, in plain English

The near-identical prevalence, 40.9% against 40.5%, in two large independent surveys is the evidence that the new criteria capture the same population as the old ones; a shift of a few percentage points either way in samples of this size would still be small. Because this is a self-reported internet survey, the figures describe symptom prevalence in people willing to complete a questionnaire, which tends to over-represent milder complaints and people with internet access. That does not undermine the comparison, which is what the paper is for, but it does mean these numbers are not caseload estimates.

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