The interpretation of Rome III criteria and method of assessment affect the irritable bowel syndrome classification of children.
BACKGROUND
Paediatric classification of irritable bowel syndrome (IBS) is complicated by the potential discrepancy between parent and child report and by the interpretation of pain-stool relations in the Rome III classification system.


OBJECTIVE
To compare IBS classification by diary and by child and parent respondents.


METHODS
Children (ages 7-10 years, n = 90) with recurrent abdominal pain and their parents completed IBS symptom questionnaires and 2-week pain and stool diaries. Diaries were coded with two algorithms, one defining stool changes individually and one defining changes normatively. Proportions of dichotomous classifications (IBS vs. not IBS) between pairs of classification methods/respondents were evaluated using Chi-squared tests (χ²) to determine whether coding methods were significantly related, the degree of inclusiveness, and whether differences in classification were randomly distributed.


RESULTS
Individual and normative diary classifications were congruent in 62% of cases, but the individual method classified more children with IBS, 53% vs. 18%. Parent and child questionnaire reports were not correlated. The normative diary classifications and parent questionnaire were the most congruent pair of methods (76% of cases).


CONCLUSIONS
Poor congruence among methods suggests that Rome III IBS criteria need better specification, and efforts to improve parent-child agreement are necessary.
Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA. danitac@bcm.edu
D I
DI
Czyzewski
M M
MM
Lane
E M
EM
Weidler
A E
AE
Williams
P R
PR
Swank
R J
RJ
Shulman
D015746:Abdominal Pain / Q000145:classification* / Q000503:physiopathology / Q000523:psychology; D000465:Algorithms; D016009:Chi-Square Distribution; D002648:Child; D003248:Constipation / Q000209:etiology*; D003967:Diarrhea / Q000209:etiology*; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000145:classification* / Q000503:physiopathology / Q000523:psychology; D010147:Pain Measurement / Q000379:methods / Q000523:psychology; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires