词条 | Rome process |
释义 |
The Rome process and Rome criteria are an international effort to create scientific data to help in the diagnosis and treatment of functional gastrointestinal disorders, such as irritable bowel syndrome, functional dyspepsia and rumination syndrome. The Rome diagnostic criteria are set forth by Rome Foundation, a not for profit 501(c)(3) organization based in Raleigh, North Carolina, United States. HistorySeveral systematic approaches attempted to classify functional gastrointestinal disorders (FGIDs). As a result, there were several key events which ultimately led to the current Rome Classification. In 1962, Chaudhary and Truelove published their study of IBS patients in Oxford, England. This was the first attempt to classify the new field of functional gastrointestinal disorders. Much of what they reported has persisted to the present day.[1] Subsequently, in 1978 came the "Manning Criteria" developed by Heaton and colleagues in Bristol. This characterized IBS-D (IBS with predominant diarrhea), but importantly, a cluster of symptoms which were characteristic for this disorder. This ultimately became the basis for Rome's symptom-based criteria for IBS.[2] From 1980 to 1994, there were several epidemiological and clinical studies evaluating symptom prevalence and frequency in healthy subjects and IBS patients. Thompson, Drossman, Talley, Whitehead, and Kruis.[3][4][5][6][7][8][9] In 1989, the first consensus-based diagnostic criteria for IBS were established.[3][10] The following year, a classification system for FGIDs was established.[3][11] From 1991 to 1993, several working teams (esophagus, gastroduodenal, bowel, biliary, anorectal) published symptom-based criteria and clinical features of the functional GI disorders within these anatomic domains in Gastroenterology International.[3][12][13][14][15][16][17] In 1993, a validated questionnaire of all the diagnostic criteria was created and was then applied in a national survey, the US Householder Survey: the first national epidemiological database on the prevalence, demographic factors, and health care seeking features of people with FGIDs.[3][18] In 1994, FGIDs were categorized into anatomical domains and resulted in a book now recognized as Rome I – The Functional Gastrointestinal Disorders: Diagnosis, Pathophysiology and Treatment – A Multinational Consensus.[3][19] The Rome criteria have been evolving from the first set of criteria issued in 1989 (The Rome Guidelines for IBS) through the Rome Classification System for functional gastrointestinal disorders (1990), or Rome-1, the Rome I Criteria for IBS (1992) and the functional gastrointestinal disorders (1994), the Rome II Criteria for IBS (1999) and the functional gastrointestinal disorders (1999) to the Rome III Criteria (2006). "Rome II" and "Rome III" incorporated pediatric criteria to the consensus. The Rome IV update was published 10 years later in May 2016.[20] This covers epidemiology, pathophysiology, psychosocial and clinical features, and diagnostic evaluation and treatment recommendations for 33 adult and 17 pediatric functional gastrointestinal disorders.[21] ProcessThe Rome criteria are achieved and finally issued through a consensual process, using the Delphi method (or Delphi technique). The Rome Foundation process is an international effort to create scientific data to help in the diagnosis and treatment of functional gastrointestinal disorders, also known as disorders of gut-brain interaction.[22] The Rome Diagnostic criteria are set forth by the Rome Foundation, an independent, not for profit 501(c)(3) organization.[22][23] The Rome FoundationThe Rome Foundation, incorporated in 1996 and based in Raleigh, North Carolina, is an independent not for profit 501(c) 3 organization. The foundation provides support for activities which foster clinical research, data and educational information which aid in the diagnosis and treatment of functional gastrointestinal disorders.[22][23][24][25] Over the last 25 years, the Rome organization has sought to legitimize and update the knowledge of functional GI disorders. This has been accomplished by bringing together scientists and clinicians from around the world to classify and critically appraise the science of gastrointestinal function and dysfunction. This knowledge permits clinical scientists to make recommendations for diagnosis and treatment that can be applied in research and clinical practice. The mission is to improve the lives of people with these disorders. The goals of the Rome Foundation are to promote global recognition and legitimization of FGIDs, advance the scientific understanding of their pathophysiology, optimize clinical management for these patients and develop and provide educational resources to accomplish these goals.[23] Definition of functional gastrointestinal disorders/disorders of gut-brain interactionUsing the Delphi method, the Rome Foundation and its Board of Directors, chairs and co-chairs of the ROME IV committees developed the current definition for disorders of gut-brain interaction.[22] A group of disorders classified by GI symptoms related to any combination of:[22]
Evolution of Rome criteriaRome IIn 1994, Rome I was published as The Functional Gastrointestinal Disorders:Diagnosis, Pathophysiology, and Treatment—A Multinational Consensus.[19] Rome IIBy the mid-1990s, the concept of FGID classification and the use of diagnostic criteria was promoted due to the US Food and Drug Administration (FDA) recommended the use of the IBS criteria for selection into pharmaceutical studies, and the pharmaceutical companies took interest in supporting the efforts of the Rome Foundation to improve the understanding, diagnosis, and treatment of FGIDs and to also apply the use of these criteria in their pharmaceutical studies. In Rome II, thepediatric population of FGIDs was added. Rome IIIAfter publication of Rome II, the number of studies published using the Rome criteria in clinical trials grew tremendously over the next 15 years. Rome III differed from Rome I and II by the use of more evidence-based rather than consensus-based data. Rome IVAfter publication of Rome III in 2006, the Rome Foundation was well recognized as the authoritative body developing diagnostic criteria for research and also for providing education about the FGIDs. Rome IV tried to address the limitations of a symptom-based criteria in several ways:
In Rome IV, the classification moved from a physiologically based classification to a symptom-based classification. The classifications were based upon organ regions (i.e. esophageal, gastroduodenal, bowel, biliary, anorectal). Rome IV criteria/classificationThe original Rome classification was first published in 1990 and has since been modified with each iteration to develop the subsequent classifications with Rome II, III and IV. Beginning with the original publication in 1990 and leading to Rome I, the classification moved from a physiologically based classification to a symptom-based classification with additional classifications based upon organ regions (i.e. esophageal, gastroduodenal, bowel, biliary, anorectal).[22] The current Rome IV classification[22] is the culmination of the evolution of a series of iterations (Rome I,[19] Rome II,[27] and Rome III[28]) with its inception as Rome I.[19] The Rome criteria are a set of criteria used by clinicians to classify a diagnosis of a patient with an FGID (disorder of gut-brain interaction). These Rome criteria are updated every 6–10 years.[24] The current Rome IV classification, published in 2016, is as follows:[21] A. Esophageal Disorders
Functional gastrointestinal disorders (FGIDs)FGIDs share in common any of several physiological features including increased motor reactivity, enhanced visceral hypersensitivity, altered mucosal immune and inflammatory function (associated with bacterial dysbiosis), and altered central nervous system and enteric nervous system (CNS-ENS) regulation. PathophysiologyThe pathophysiology of FGID has been best conceptualized using biopsychosocial model help to explain the relationships between an individual factors in their early life that intern can influence their psychosocial factor and physiological functioning. This model also shows the complex interactions between these factors through the brain-gut axis.[26][29][30][31][32] These factors affect how FGID manifest in terms of symptoms but also affect the clinical outcome. These factors are interconnected and the influences on these factors are bidirectional and mutually interactive. Early life factorsEarly life factors include genetic factors, psychophysiological and sociocultural factors, and environmental exposures.
Psychosocial factorsPsychosocial factors influence the functioning of the GI tract through the brain-gut axis (motility, sensitivity, barrier function). They also affect experience and behavior, treatment selection and the clinical outcome. Psychological stress or one's emotional response to stress exacerbates gastrointestinal symptoms and may contribute to FGID development.[37][38] PhysiologyThe physiology of FGID is characterized by abnormal motility, visceral hypersensitivity as well as dysregulation of the immune system and barrier function of the GI tract as well as inflammatory changes.
Brain-gut axisThe brain-gut axis is the mechanism in which the psychosocial factors influence the GI tract and vice versa. There is communication between emotional and cognitive centers of the brain to the GI tract and vice versa.[48] Emotions have been shown to stimulate colon motor function and result in decreased colonic transit time, increased contractile activity, the induction of defecation, and symptoms of diarrhea.[26] References and sources1. ^Chaudhary NA, Truelove SC. The irritable colon syndrome. A study of the clinical features, predisposing causes, and prognosis in 130 cases. Q J Med 1962;31:307–322. 2. ^Manning AP, Thompson WG, Heaton KW et al. Towards positive diagnosis of the irritable bowel. Br Med J 1978;2:653–654. 3. ^1 2 3 4 5 6 Torsoli A, Corazziari E. The WTR's, the Delphic Oracle and the Roman Conclaves Gastroenterol Int 1991;4:44–45. 4. ^Thompson WG, Heaton KW. Functional bowel disorders in apparently healthy people. Gastroenterology 1980;79:283–288. 5. ^Drossman DA, Sandler RS, McKee DC, et al. Bowel patterns among subjects not seeking health care. Use of a questionnaire to identify a population with bowel dysfunction. Gastroenterology 1982;83:529–534. 6. ^Sandler RS, Drossman DA, Nathan HP, et al. Symptom complaints and health care seeking behavior in subjects with bowel dysfunction. Gastroenterology 1984;87:314–318. 7. ^Talley NJ, Phillips SF, Melton LJ, et al. A patient questionnaire to identify bowel disease. Ann Intern Med 1989;111:671–674 8. ^Kruis W, Thieme CH, Weinzierl M, et al. A diagnostic score for the irritable bowel syndrome. Its value in the exclusion of organic disease. Gastroenterology 1984;87:1–7. 9. ^Drossman DA. Diagnosis of the irritable bowel syndrome: A simple solution? Gastroenterology 1984;87:224–225 10. ^Thompson WG, Dotevall G, Drossman DA, et al. Irritable bowel syndrome: Guidelines for the diagnosis. Gastroenterol Int 1989;2:92–95. 11. ^Drossman DA, Thompson WG, Talley NJ, et al. Identification of subgroups of functional bowel disorders. Gastroenterol Int 1990;3:159–172. 12. ^Richter JE, Baldi F, Clouse RE, et al. Functional oesophageal disorders. Gastroenterol Int 1992;5:3–17 13. ^Talley NJ, Colin-Jones D, Koch KL, et al. Functional dyspepsia: a classification with guidelines for diagnosis and management. Gastroenterol Int 1991;4:145–160 14. ^Thompson WG, Creed F, Drossman DA, et al. Functional bowel disorders and chronic functional abdominal pain. Gastroenterol Int 1992;5:75–91 15. ^Corazziari E, Funch-Jensen P, Hogan WJ, et al. Working team report: functional disorders of the biliary tract. Gastroenterol Int 1993;6:129–144. 16. ^Whitehead WE, Devroede G, Habib FI, et al. Functional disorders of the anorectum. Gastroenterol Int 1992;5:92–108. 17. ^Talley NJ, Nyren O, Drossman DA, et al. The irritable bowel syndrome: toward optimal design of controlled treatment trials. Gastroenterol Int 1993;4:189–211 18. ^Drossman DA, Li Z, Andruzzi E, et al. U.S. householder survey of functional gastrointestinal disorders: prevalence,sociodemography and health impact. Dig Dis Sci 1993;38:1569–1580. 19. ^1 2 3 Drossman DA, Richter JE, Talley NJ, et al. The functional gastrointestinal disorders: diagnosis, pathophysiology and treatment. McLean (VA): Degnon Associates, 1994. 20. ^{{cite journal |vauthors=Drossman DA, Hasler WL |title=Rome IV-Functional GI Disorders: Disorders of Gut-Brain Interaction |journal=Gastroenterology |volume=150 |issue=6 |pages=1257–61 |year=2016 |pmid=27147121 |doi=10.1053/j.gastro.2016.03.035 |url=}} 21. ^1 {{cite journal |vauthors=Drossman DA |title=Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV |journal=Gastroenterology |volume=150 |issue=6 |pages=1262–1279|year=2016 |pmid=27144617 |doi=10.1053/j.gastro.2016.02.032 |url=}} 22. ^1 2 3 4 5 6 Drossman DA. The Rome IV Committees, editor. Functional Gastrointestinal Disorders and the Rome IV process. In: Drossman DA, Chang L, Chey WD, Kellow J, Tack J, Whitehead WE, editors. Rome IV functional gastrointestinal disorders: disorders of gut-brain interaction. I. Raleigh, NC: The Rome Foundation; 2016. pp. 1–32. 23. ^1 2 https://theromefoundation.org 24. ^1 "Meet the Rome Foundation," 2017. Retrieved from https://theromefoundation.org/wp-content/uploads/Meet-The-Rome-Foundation-2017-web.pdf 25. ^https://theromefoundation.org/presentations-videos/ 26. ^1 2 Drossman DA. The Rome IV Committees, editor. Functional Gastrointestinal Disorders and the Rome IV process. In: Drossman DA, Chang L, Chey WD, Kellow J, Tack J, Whitehead WE, editors. Rome IV functional gastrointestinal disorders: disorders of gut-brain interaction.I. Raleigh, NC: The Rome Foundation; 2016. pp 1–32. 27. ^Drossman DA, Corazziari E, Talley NJ, et al., eds. Rome II: the functional gastrointestinal disorders. 2nd ed. McLean (VA): Degnon Associates, 2000. 28. ^Drossman DA, Corazziari E, Delvaux M, et al., eds. Rome III: the functional gastrointestinal disorders. 3rd ed. McLean (VA): Degnon Associates, 2006. 29. ^Drossman DA. Biopsychosocial issues in gastroenterology. In: Feldman M, Friedman LS, and Brandt LJ ads. Sleisenger and Fordtran's gastrointestinal and liver disease. 10th ed. Philadelphia: Saunders Elsevier, 2015:349–362. 30. ^Mayer EA, Savage T, Shulman RJ. Brain-gut microbiome interactions and functional bowel disorders. Gastroenterology 2014;146:1500–1512. 31. ^Jones MP, Dilley JB, Crowell MD et al. Brain-gut connections in functional GI disorders: anatomic and physiological relationships. Neurogastroenterol Motel 2006; 18:91–103 32. ^Drossman DA. Presidential Address Address: Gastrointestinal Illness and the Biopsychosocial Model. Psychosomatic Medicine 1998;60:258–267 33. ^Saito YA, TAlley NJ. Genetics of irritable bowel syndrome. Am J Gastroenterol 2008;103:2100–2104. 34. ^Tran L, Chaloner A, Sawalha AH, et al. Importance of epigenetic mechanisms in visceral pain induced by chronic water avoidance stress. Psychoneuroendocrinology 2013;38:898–906 35. ^Zborowski M. Cultural components in responses to pain. J Social Issues 1952;8:16–30. 36. ^Cremon C, Stanghellini V, Pallotti F, et al. Salmonella gastroenteritis during childhood is a risk factor for irritable bowel syndrome in adulthood. Gastroenterology 2014:147:69–77 37. ^Drossman DA. The Rome IV Committees, editor. Functional Gastrointestinal Disorders and the Rome IV process. In: Drossman DA, Chang L, Chey WD, Kellow J, Tack J, Whitehead WE, editors. Rome IV functional gastrointestinal disorders: disorders of gut-brain interaction. I. Raleigh, NC: The Rome Foundation; 2016. pp 1–32. 38. ^Collins SM, Chang C, Mearin F. Postinfectious chronic gut dysfunction: from bench to bedside. Am J Gastroenterol Suppl 2012;1:2–8 39. ^Camilleri M. Peripheral mechanisms in irritable bowel syndrome. N Engl J Med 2012;367:1626–1635 40. ^Delgado-Aros S, Camilleri M. Visceral hypersensitivity. J Clin Gastronenterol 2005;39:S194-S203 41. ^Mayer EA, Gebhart GF. Basic and clinical aspects of visceral hyperalgesia. Gastroenterology 1994;107:271–293 42. ^Zhou Q, Zhang B, Verne GE. Intestinal membrane permeability and hypersensitivity in the irritable bowel syndrome. Pain 2009;146:41–46 43. ^Camilleri M, Madsen K, Spiller R, et al. Intestinal barrier function in health and gastrointestinal disease. Neurogastroenterol Motil 2012; 24:503–512 44. ^Mayer EA, Savage T, Shulman RJ. Brain-gut micro biome interactions and functional bowel disorders. Gastroenterology 2014;146:1500–1512. 45. ^Simrén M, Barbara G, Flint HJ, et al. Intestinal microbiota in functional bowel disorders: a Rome Foundation working team report. Gut 2013;1:159–176 46. ^Chey WD. The role of food in the functional gastrointestinal disorders: introduction to a manuscript series. Am J Gastroenterol 2013;108:694–697. 47. ^Rajilic-Stojanavic M, Jonkers DM, Salonen A, et al. Intestinal microbiota and diet in IBS: causes, consequences, or epiphenomena? Am J Gastroenterol 2015; 110:278–287. 48. ^Gaman A, Kuo B. Neuromodulatory processes of the brain-gut axis. Neuromodulation 2008; 11:249–259
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2 : Gastroenterology|Diagnostic gastroenterology |
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