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Title: The interpretation of Rome II criteria and method of assessment affect the irritable bowel syndrome classification of children

Author
item CZYZEWSKI, DAMITA - Baylor College Of Medicine
item LANE, MARIELLA - Baylor College Of Medicine
item WEIDLER, ERICA - Children'S Nutrition Research Center (CNRC)
item WILLIAMS, AMY - Baylor College Of Medicine
item SWANK, PAUL - University Of Texas Health Science Center
item SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC)

Submitted to: Alimentary Pharmacology & Therapeutics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/16/2010
Publication Date: 3/1/2011
Citation: Czyzewski, D.I., Lane, M.M., Weidler, E.M., Williams, A.E., Swank, P.R., Shulman, R.J. 2011. The interpretation of Rome II criteria and method of assessment affect the irritable bowel syndrome classification of children. Alimentary Pharmacology & Therapeutics. 33(3):403-411.

Interpretive Summary: Abdominal pain in children is very frequent and very commonly affects their ability to attend school and activities. Sometimes abdominal pain may be accompanied by other symptoms, such as loose stools or be related to diet. In order to understand better these different types of abdominal pain, attempts have been made to categorize them. However, it is not clear how useful these categorizations are. This study sought to determine how interpreting the classification system in different ways affected how children were grouped. It also compared how children categorized themselves as opposed to how they were categorized by their parents. The results showed that how children were grouped depended on how the person using the classification system interpreted it. The results also demonstrated that children and their parents often have different views of the child’s symptoms.

Technical Abstract: Pediatric 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. The aim of this study was to compare IBS classification by diary and by child and parent respondents. Children (ages 7–10 years) 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 to determine whether coding methods were significantly related, the degree of inclusiveness, and whether differences in classification were randomly distributed. Our results showed that 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). We concluded that poor congruence among methods suggests that Rome III IBS criteria need better specification, and efforts to improve parent-child agreement are necessary.