Inconsistent symptom clusters for functional gastrointestinal disorders in Asia: is Rome burning?

• Published in: Gut Vol. 67; no. 11; pp. 1911 - 1915
• Main Authors: Holtmann, Gerald J, Talley, Nicholas J
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.11.2018
• Subjects: Biomarkers; Burning; Clinical trials; Constipation; Diarrhea; Dysphagia; Gastroenterology; Gastroesophageal reflux; Gastrointestinal diseases; Gene expression; Irritable bowel syndrome; Mucosa; Pain; Patients; Questionnaires; Systematic review; Vomiting; epidemiology; functional dyspepsia; irritable bowel syndrome; functional bowel disorder
• ISSN: 0017-5749; 1468-3288; 1468-3288
• DOI: 10.1136/gutjnl-2017-314775

If categories and subsequent selection criteria are not ‘right’, the therapeutic gain over placebo of a specific drug treatment targeting a specific disease mechanism that is only relevant in a subgroup of patients may be very small. [...]in a cohort of patients (meeting specific Rome criteria) with heterogeneous underlying pathophysiologies,45 the overall effects may appear small and the treatment may end up falsely being considered ineffective. A combination of gene expression and serological markers in combination with psychological measures shows exciting progress towards a diagnostic test for IBS compared with healthy subjects, and to discriminate IBS-C from IBS-D.47 Other examples are markers of changes in bile acid balance, such as elevated bile acid in the stool, and altered colonic transit.48 There is also the potential for microbial studies and mucosal proteases as future actionable biomarkers.49 However, more work is needed to be done to validate the role of biomarkers to diagnose FGID and how to guide therapy. [...]in the future incorporating specific biologic markers might greatly enhance the clinical utility of future criteria for FGID. [...]the criteria as written may not be applicable across the world and especially in Asia. [...]the obvious shortcomings of the current Rome criteria should stimulate modifications that ultimately will improve patient outcomes.