UEG Journal Abstracts 2022 - 65

symptoms interact within and across diagnostic categories by identifying
most central and bridge symptoms. Symptoms with highest centrality or
core symptoms (i.e. those connected with most other symptoms) are theorized
to maintain the disorders and/or their comorbidity, and may therefore
constitute preferential targets for intervention. Bridge symptoms connect
networks of symptoms belonging to different diagnoses and could
help illuminate pathways of overlap across DGBI diagnostic categories.
DGBI are well-suited for a network approach given their symptom-based
nature and high levels of overlap among them.
Aims & Methods: We used all continuously and ordinal scored items from
the Rome IV Diagnostic Questionnaire collected from the Rome Foundation
Global Epidemiology Study internet surveys (26 countries) to identify:
1. The core symptoms in a global network of all symptom items;
2. Core symptoms within each network corresponding to a Rome IV DGBI
category (i.e. Esophageal, Gastroduodenal, Bowel); and,
3. Symptom pathways connecting DGBI category networks (i.e. bridge
symptoms).
We estimated symptoms networks using the Glasso method1
among
adults (N=20,229; age Mean=42.2, SD=15.5; 57% female) who met criteria
for at least one DGBI. We calculated network stability indices to assess
reliability and accuracy. We did not estimate an Anorectal DGBI network
due to insufficient (i.e. only two) items, but the items were included in the
bridge analysis.
Results: Network stability was excellent in all networks (>0.7). Within the
global (all symptom) network, the most central symptoms were abdominal
pain (Strength [S]=2.27) and epigastric pain (S=2.06). In each DGBI
category network, the most central symptoms were as follows: burning
associated with chest pain in the Esophageal network (S=1.65); retching
associated with regurgitation in the Gastroduodenal network (S=1.48);
sensation of stool blockage when having a bowel movement in the
Bowel network (S=1.65). The symptom with the highest bridge centrality
was general abdominal pain ( " pain anywhere in your abdomen; " Bridge
strength=0.03; in Bowel) and was most strongly connected to epigastric
pain (part r=.14; in Epigastric), chest pain (part r=.10; in Esophageal), and
the Anorectal symptom rectal pain (part r=.04; in Anorectal).
Conclusion: This study provides novel transdiagnostic information about
core symptoms of Rome IV DGBI, within and across existing categories.
Abdominal pain was at the core of the global symptom network and for
pathways connecting DGBI diagnostic categories. Interestingly, within
each GI tract area, the core symptoms were sensations (e.g. stool blockage
sensation) rather than quantifiable outcomes (e.g. frequency of hard/
lumpy stool).
These findings suggest that pain may be a transdiagnostic factor in DGBI
and its role in diagnostic classification of DGBI should be studied further.
In particular, abdominal pain could be a key treatment target as its improvement
may positively impact the severity of other GI symptoms irrespective
of their location. Future longitudinal research is needed to evaluate
the clinical utility of symptom networks, including if they are predictive
of treatment outcomes.
References:
1. Epskamp S, Cramer AO, Waldorp LJ, Schmittmann VD, Borsboom D.
qgraph: Network visualizations of relationships in psychometric data.
Journal of statistical software.2012;48(1):1-18.
Disclosure: HBM, LG, IAV, TAB, LVO, ADS,OP, and SIB have no personal or
financial conflicts to declare.KS has received research support from Ironwood
and Urovant, and has served as a consultant to Arena, Gelesis, GI
Supply, and Shire/Takeda.
OP083
CAUSES OF LOWER ROME IV VS. ROME III IRRITABLE BOWEL
SYNDROME (IBS) PREVALENCE: ANALYSIS OF DATA FROM THE ROME
FOUNDATION GLOBAL EPIDEMIOLOGY STUDY (RFGES)
O.S. Palsson1
, J. Hreinsson2, H. Törnblom3
A.D. Sperber5, S. Bangdiwala6, M. Simrén7
1
, N. Tornkvist4
Sahlgrenska University
,
University of North Carolina, Chapel Hill, Dept. of Medicine,
Chapel Hill, NC, United States, 2
Hospital, Department of Internal Medicine, Section of
Gastroenterology, Gothenburg, Sweden, 3
Inst of Medicine,
Department of Molecular and Clinical Medicine, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden,
4
Institute of Medicine, Sahlgrenska University hospital,
Department of Internal Medicine and Clinical Nutrition,
Gothenburg, Sweden, 5
Faculty of Health Sciences, Farod, Israel, 6
Ben-Gurion University of the Negev,
McMaster University,
Hamilton, Canada, 7Sahlgrenska University Hospital, Dept of
Internal Medicine, Gothenburg, Sweden
Contact E-Mail Address: Olafur_Palsson@med.unc.edu
Introduction: IBS prevalence is substantially lower when using Rome IV
vs. Rome III diagnostic criteria. Analysis of a population sample from the
United States, United Kingdom and Canada1
indicated that most of this
prevalence drop (80%) was due to the raising of the abdominal pain frequency
diagnostic threshold, but it is unknown whether this applies in the
global population.
Aims & Methods: We aimed to assess the relative contributions of different
factors to Rome III vs. Rome IV IBS prevalence change in the global population,
using RFGES2
Internet survey data from the 14 countries where respondents
answered both Rome III and IV IBS diagnostic questions.
After excluding people reporting a history suggestive of organic bowel
symptom causes, those who reported abdominal pain/discomfort at or
above the Rome III diagnostic frequency threshold with ≥ 6 months duration,
were selected as the analysis dataset. Effects of the 3 different main
criteria changes from Rome III to IV (Steps 1 to 3 below) were then analyzed
sequentially.
Results: The 29609 respondents (48.6% females; mean age 43.7 years,
range 18-97) had an IBS prevalence of 10.1% by Rome III criteria and 3.8%
by Rome IV criteria. Of those, 3921 people reporting no organic GI disease
met the Rome III abdominal pain/discomfort frequency threshold of> 2-3
times a month and were included in the analyses below.
Step 1. Effect of removing the term " discomfort " from the abdominal pain
symptom wording: Starting with the 3921 cases as defined above, 993 fewer
people reported abdominal pain on the Rome IV diagnostic questionnaire
at the Rome III minimum frequency (2-3 days a month), compared to
those meeting equivalent frequency threshold on the Rome III question,
which asks about " abdominal discomfort or pain " . This quantified the
impact of dropping " discomfort " from this symptom question in isolation
from other criteria changes.
Step 2. Effect of raising the minimum pain frequency threshold in Rome IV:
Of the remaining 2928 people who reported abdominal pain at least 2-3
times a month on the Rome IV questionnaire, 1437 fewer reported at least
weekly abdominal pain, eliminating from Rome IV IBS about half of those
who met the lower Rome III frequency threshold.
Step 3. Effect of changes in stool-associated criteria: Of the people meeting
Rome IV pain frequency threshold for IBS, 1303 met the Rome III stoolassociated
criteria (such as change in stool form or frequency with pain
onset) needed for IBS diagnosis, but 162 fewer individuals qualified for
the equivalent but somewhat different Rome IV stool-associated criteria
for IBS diagnosis.
Vol. 10 | October 2022
65
Tuesday, October 11, 2022
Monday, October 10, 2022
Sunday, October 9, 2022
UEG Journal Abstracts 2022

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