Can We Rely on the Rome IV Questionnaire to Diagnose Children With Functional Gastrointestinal Disorders?

Abstract

Background/AimsTo investigate the intra-rater (test-retest) reliability of the diagnosis of functional gastrointestinal disorders (FGIDs) as measured by the Questionnaire on Pediatric Functional Gastrointestinal Disorders, Rome IV version (QPGS-IV) in children. MethodsA prospective cohort study was conducted in a public school in Cali, Colombia. Children and adolescents between 11 and 18 years of age were given the self-report Spanish version of the QPGS-IV at day 0 (baseline) and at day 2 (48 hours later). ResultsThe study protocol was completed by 215 children, of which 97 (45%) were excluded from analysis due to the inability to follow the questionnaire's instructions. The final analysis included data of 118 children (mean age 15.0 ± SD 1.8 years old, 58.5% boys). The most common diagnoses were functional dyspepsia, functional constipation, and irritable bowel syndrome. We found a moderate intra-rater reliability (κ = 0.61-0.65) for diagnosing an FGID in general, a functional abdominal pain disorder, and the diagnosis of functional dyspepsia. We found a weak intra-rater reliability (κ = 0.46-0.54) for diagnosing a functional defecation disorder, functional constipation, irritable bowel syndrome, and the postprandial distress syndrome subtype of functional dyspepsia. ConclusionsOur study shows that a large proportion of children cannot adequately complete the QPGS-IV and that the intra-rater reliability among those who did adequately follow the instructions is moderate. We advise to test the children's understanding of the instructions prior to completion of questionnaires and recommend to not rely exclusively on a self-reported questionnaire to select, recruit, or evaluate pediatric patients for FGIDs for research purposes.

Development and validation of the Early Pediatric Groningen Defecation and Fecal Continence questionnaire

“…The results show a moderate overall agreement between the test and retest of the EP-DeFeC, which corroborates with the overall reproducibility of the adult DeFeC [ 8 ]. The reliability of the Rome IV criteria within the EP-DeFeC was comparable to previous reports [ 33 ]. Nevertheless, there was a remarkable difference between the high percentages of observed agreement of some questions and low kappa coefficients.…”

Validation of red flags in the workup of children with long‐term abdominal pain – A retrospective study

“…This is not in line with the Rome committee's recommendations, which suggest limiting the number of tests if red flags are lacking. [8][9][10][11][12] As for the analyses recommended as a basic workup (IgA-transglutaminase, blood count, c-reactive protein/erythrocyte sedation and dipstick urine analysis), the frequency of carrying out these tests was high with no significant difference if the patient in the workup had a red flag or not. This is in line with the Swedish guidelines that all patients with long-term abdominal pain should undergo routine testing, despite red flags or not.…”

“…For children aged 4–10 years, the Rome foundation offers a parent report form and for children 10 years of age and older, there is another report form aimed to be filled in by the child/adolescent themselves 7,8 . Validation of the paediatric questionnaires is still ongoing, and the Rome committee's recommendations are mostly based on expert opinion, including a consensus to limit the number of tests if red flags are lacking 8–12 . However, the validation of red flags is scarce, and there are few studies specifically evaluating the significance of the Rome IV alarm features alone or grouped 13,14 …”

“…7,8 Validation of the paediatric questionnaires is still ongoing, and the Rome committee's recommendations are mostly based on expert opinion, including a consensus to limit the number of tests if red flags are lacking. [8][9][10][11][12] However, the validation of red flags is scarce, and there are few studies specifically evaluating the significance of the Rome IV alarm features alone or grouped. 13,14 The paediatric Rome IV criteria underscore that diagnostic procedures assessing possible organic disease should be kept to a minimum, and the dictum 'no evidence for organic disease' has been replaced by 'after appropriate medical evaluation the symptoms cannot be attributed to another medical condition'.…”

Prevalencia de dispepsia funcional en adolescentes cubanos

“…En la presente investigación se encontró que el 29,1 % de los adolescentes cumplía los criterios para algún TDF, se identificó DF en el 3,5 % y es más frecuente el SDP que el SDE. Nuestros resultados son similares a lo reportado por Saps y colaboradores (7) en niños colombianos, con una prevalencia para DF del 3 %; que es inferior a lo descrito por Robin y colaboradores (8) en niños norteamericanos y por Baleeman y colaboradores (9) en niños colombianos, entre el 7,2 % y 16,1 %, respectivamente; y es superior a lo informado por Zeevenhooven y colaboradores (10) en adolescentes de Curazao, cuya prevalencia para DF fue del 1,9 %. Una de las posibles explicaciones entre estas diferentes cifras, entre otras, es la manera en que se realizaron estas entrevistas: en los niños norteamericanos (8) se toman los datos de las autorrespuestas de las madres; en los niños colombianos (7,9) , los cuestionarios los respondieron ellos mismos por autorrespuesta, y a los niños de Curazao (10) se les aplicó el QPGS-III, mientras que la interpretación de los datos para identificar algún TDF se realizó según el QPGS-IV.…”