Validity and Reliability of the Japanese Version of the Rome III Diagnostic Questionnaire for Irritable Bowel Syndrome and Functional Dyspepsia

( Motoyori Kanazawa ),( Shigemi Nakajima ),( Tadayuki Oshima ),( William E Whitehead ),( Ami D Sperber ),( Olafur S Palsson ),( Douglas A Drossman ),( Hiroto Miwa ),( Shin Fukudo ) 대한소화기기능성질환·운동학회 2015 Journal of Neurogastroenterology and Motility (JNM Vol.21 No.4

Background/Aims Reliable diagnostic instruments for measuring the presence of functional gastrointestinal disorders based on the Rome III criteria have been lacking in Japan. The aims of the present study were to translate and validate the Rome III diagnostic questionnaire which was widely used in Western countries. Methods The original version of Rome III diagnostic questionnaire was translated from English into Japanese through 3 independent forward translations, resolution, back translation and reconciliation of the differences. Forty-nine patients with irritable bowel syndrome (IBS), 32 patients with functional dyspepsia (FD) and 56 subjects without any current GI symptoms as controls were recruited from three hospitals located in different regions of Japan and completed the IBS and FD diagnostic modules twice within 14 days. Kappa statistic was used to assess test-retest reliability. The sensitivity and specificity of each diagnostic module for distinguishing IBS or FD patients from controls was tested. Results Median kappa statistics were 0.63 for the translated IBS diagnostic module and 0.68 for the FD module. The sensitivity, specificity, and positive predict value of the IBS module against physician diagnosis was 61.2%, 100%, and 100% and those of the FD module was 53.2%, 98.2%, and 94.4%, respectively. Meanwhile, IBS patients were significantly more likely to report blood in stools compared to controls (18.4% vs 1.8%, P < 0.01). Conclusions The IBS and FD diagnostic modules on the Japanese version of the Rome III diagnostic questionnaire are valid and reliable. Further studies are warranted to elucidate the diagnostic utility of the red flag questionnaire. (J Neurogastroenterol Motil 2015;21:537-544)

Anti-Enteric Neuronal Antibodies and the Irritable Bowel Syndrome

( Jackie D Wood ),( Su Mei Liu ),( Douglas A Drossman ),( Yehuda Ringel ),( William E Whitehead ) 대한소화기기능성질환·운동학회 (구 대한소화관운동학회) 2012 Journal of Neurogastroenterology and Motility (JNM Vol.18 No.1

Background/Aims Functional gastrointestinal disorders are those in which no abnormal metabolic or physical processes, which can account for the symptoms, can be identified. The irritable bowel syndrome (IBS) is a significant functional disorder, which affects 10-20 percent of the population worldwide. Predominant symptoms of IBS are abnormal defecation associated with abdominal pain, both of which may be exacerbated by psychogenic stress. Our study was designed to test a hypothesis that symptoms in a subset of patients with a diagnosis of IBS are associated with an autoimmune degenerative neuropathy in the enteric nervous system. Methods Serum was collected from Rome II-IBS patients and controls at the University of North Carolina Functional Gastrointestinal Diseases Center. Assay procedures were immunohistochemical localization of antibody binding to enteric neurons and human protein microarray assay for antigens recognized by antibodies in the sera. Results Eighty-seven percent of IBS sera and 59% of control sera contained anti-enteric neuronal antibodies. Antibody immunostaining was seen in the nucleus and cytoplasm of neurons in the enteric nervous system. Protein microarray analysis detected antibody reactivity for autoantigens in serum with anti-enteric neuronal antibodies and no reactivity for the same autoantigens in samples not containing anti-enteric neuronal antibodies in our immunostaining assay. Antibodies in sera from IBS patients recognized only 3 antigens out of an 8,000 immunoprotein array. The 3 antigens were: (1) a nondescript ribonucleoprotein (RNP-complex); (2) small nuclear ribonuclear polypeptide A; and (3) Ro-5,200 kDa. Conclusions Results of the present study suggest that symptoms in a subset of IBS patients might be a reflection of enteric neuronal dam - age or loss, caused by circulating anti-enteric autoimmune antibodies. (J Neurogastroenterol Motil 2012;18:78-85)

Increased Postprandial Colonic Motility and Autonomic Nervous System Activity in Patients With Irritable Bowel Syndrome: A Prospective Study

( Yukari Tanaka ),( Motoyori Kanazawa ),( Olafur S Palsson ),( Miranda A Van Tilburg ),( Lisa M Gangarosa ),( Shin Fukudo ),( Douglas A Drossman ),( William E Whitehead ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2018 Journal of Neurogastroenterology and Motility (JNM Vol.24 No.1

Background/Aims The prevalence and severity of irritable bowel syndrome (IBS) declines with age, but the cause of this is unknown. This study tested 2 hypotheses: (1) autonomic nervous system responses to eating and bowel distention, measured by heart rate variability (HRV), differs by age in IBS patients and (2) HRV is correlated with colonic motility and IBS symptoms. Methods One hundred and fifty-six Rome III positive IBS patients and 31 healthy controls underwent colonic manometry with bag distention in the descending colon, followed by ingestion of an 810-kcal meal. HRV, evaluated by low frequency (%LF; 0.04-0.15 Hz) component, high frequency (%HF; 0.15-0.40 Hz) component, and the LF/HF ratio, was measured during colonic distention and after the meal. Motility index and subjective symptom scores were simultaneously quantified. Results Both colonic distention and eating decreased %HF and increased the LF/HF ratio, and both indices of autonomic nervous system correlated with age. In IBS patients, %HF negatively correlated with the postprandial motility index after adjusting for age. The %HF and LF/HF ratios also correlated with psychological symptoms but not bowel symptoms in IBS patients. Conclusion Decreased vagal activity is associated with increase in age and greater postprandial colonic motility in patients with IBS, which may contribute to postprandial symptoms. (J Neurogastroenterol Motil 2018;24:87-95)

Translation and Validation of Enhanced Asian Rome III Questionnaires in Bengali Language for Diagnosis of Functional Gastrointestinal Disorders

( M Masudur Rahman ),( Uday C Ghoshal ),( A H M Rowshon ),( Faruque Ahmed ),( Md Golam Kibria ),( Mahmud Hasan ),( Kok-ann Gwee ),( William E Whitehead ) 대한소화기기능성질환·운동학회 2016 Journal of Neurogastroenterology and Motility (JNM Vol.22 No.2

Background/Aims Functional gastrointestinal disorders (FGIDs), diagnosed by symptom-based criteria due to lack of biomarkers, need translatedvalidated questionnaires in different languages. As Bengali, the mother tongue of Bangladesh and eastern India, is the seventh most spoken language in the world, we translated and validated the Enhanced Asian Rome III questionnaire (EAR3Q) in this language. Methods The EAR3Q was translated in Bengali as per guideline from the Rome Foundation. The translated questionnaire was validated prospectively on Bengali-speaking healthy subjects (HS, n = 30), and patients with functional dyspepsia (FD, n = 35), irritable bowel syndrome (IBS, n = 40) and functional constipation (FC, n = 12) diagnosed by clinicians using the Rome III criteria. The subjects were asked to fill-in the questionnaire again after 2 weeks, to check for its reproducibility. Results During translation, the original and the backward translated English versions of the questionnaire demonstrated high concordance. Sensitivity of the Bengali questionnaire to diagnose patients with FD, IBS, FC, and HS was 100%, 100%, 75%, and 100%, respectively, considering diagnosis by the clinicians as the gold standard. On test-retest reliability analysis, Kappa values for FD, IBS, FC, and HS were 1.0, 1.0, 0.83, and 1.0, respectively. The Bengali questionnaire detected considerable overlap of FD symptoms among patients with IBS, IBS among patients with FD, and FD among patients with FC, which were not detected by the clinicians. Conclusions We successfully translated and validated the EAR3Q in Bengali. We believe that this translated questionnaire will be useful for clinical evaluation and research on FGIDs in the Bengali-speaking population. (J Neurogastroenterol Motil 2016;22:240-247)