title: Functional gastrointestinal disorders in eating disorder patients: altered distribution and predictors using ROME III compared to ROME II criteria.
abstract: OBJECTIVE
  To compare the prevalence of Functional gastrointestinal disorders (FGIDs) using ROME III and ROME II and to describe predictors of FGIDs among eating disorder (ED) patients.
  
  
  METHODS
  Two similar cohorts of female ED inpatients, aged 17-50 years, with no organic gastrointestinal or systemic disorders, completed either the ROME III (n = 100) or the ROME II (n = 160) questionnaire on admission for ED treatment. The two ROME cohorts were compared on continuous demographic variables (e.g., age, BMI) using Student's t-tests, and on categorical variables (e.g., ED diagnosis) using χ(2)-tests. The relationship between ED diagnostic subtypes and FGID categories was explored using χ(2)-tests. Age, BMI, and psychological and behavioural predictors of the common (prevalence greater than 20%) ROME III FGIDs were tested using logistic regression analyses.
  
  
  RESULTS
  The criteria for at least one FGID were fulfilled by 83% of the ROME III cohort, and 94% of the ROME II cohort. There were no significant differences in age, BMI, lowest ever BMI, ED diagnostic subtypes or ED-related quality of life (QOL) scores between ROME II and ROME III cohorts. The most prevalent FGIDs using ROME III were postprandial distress syndrome (PDS) (45%) and irritable bowel syndrome (IBS) (41%), followed by unspecified functional bowel disorders (U-FBD) (24%), and functional heartburn (FH) (22%). There was a 29% or 46% increase (depending on presence or absence of cyclic vomiting) in functional gastroduodenal disorders because of the introduction of PDS in ROME III compared to ROME II. There was a 35% decrease in functional bowel disorders (FBD) in Rome III (excluding U-FBD) compared to ROME II. The most significant predictor of PDS was starvation (P = 0.008). The predictor of FH (P = 0.021) and U-FBD (P = 0.007) was somatisation, and of IBS laxative use (P = 0.025). Age and BMI were not significant predictors. The addition of the 6-mo duration of symptoms requirement for a diagnosis in ROME III added precision to many FGIDs.
  
  
  CONCLUSIONS
  ROME III confers higher precision in diagnosing FGIDs but self-induced vomiting should be excluded from the diagnosis of cyclic vomiting. Psychological factors appear to be more influential in ROME II than ROME III.
authors.affiliation: Xiaojie Wang, Catherine Boyd, Department of Obstetrics and Gynaecology, University of Sydney, NSW 2006, Australia.
authors.forename: Xiaojie
authors.initials: X
authors.lastname: Wang
authors.affiliation: Xiaojie Wang, Catherine Boyd, Department of Obstetrics and Gynaecology, University of Sydney, NSW 2006, Australia.
authors.forename: Georgina M
authors.initials: GM
authors.lastname: Luscombe
authors.affiliation: Xiaojie Wang, Catherine Boyd, Department of Obstetrics and Gynaecology, University of Sydney, NSW 2006, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Boyd
authors.affiliation: Xiaojie Wang, Catherine Boyd, Department of Obstetrics and Gynaecology, University of Sydney, NSW 2006, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Kellow
authors.affiliation: Xiaojie Wang, Catherine Boyd, Department of Obstetrics and Gynaecology, University of Sydney, NSW 2006, Australia.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Abraham
mesh_terms: D000293:Adolescent; D000328:Adult; D016009:Chi-Square Distribution; D005247:Feeding Behavior; D001068:Feeding and Eating Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009517:New South Wales; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
keywords: Anorexia nervosa; Bulimia nervosa; Eating disorders; Gastrointestinal diseases; Irritable bowel syndrome