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====== Functional Bowel Symptoms (Rome III) ======

The Rome III IBS Diagnostic Questionnaire is a survey to assess whether individuals meet the diagnostic criteria for [[https://en.wikipedia.org/wiki/Irritable_bowel_syndrome|Irritable Bowel Syndrome (IBS)]]((Whitehead WE et al. (2006) Development and validation of the Rome III diagnostic questionnaire. In Rome III: The Functional Gastrointestinal Disorders, 3rd edn Degnon Associates: McLean, VA, 835–853))([[sections|section]]: [[Diseases & symptoms]]).\\
The Rome III diagnostic criteria are set forth by the [[https://theromefoundation.org/|Rome Foundation]].\\
The Rome III Survey was implemented in [[start|Lifelines]] general assessment [[2A]] and was used in additional assessments on intestinal health and microbiome ([[DEEP]] and [[DAG3]]). An [[ibs_diagnostic_score|IBS diagnostic score]] according to the ROME III has been developed and is available for use.

===== Background =====
Lifelines repeatedly assessed the presence of IBS by [[digestive system diseases|self-report]]. However, recent studies indicate that this method misses ~69% of IBS diagnoses((Warren JW, Clauw DJ (2012). Functional somatic syndromes: sensitivities and specificities of self-reports of physician diagnosis. Psychosomatic Medicine 74(9):891-895)). The Rome III IBS DQ improves the identification of participants that meet the diagnostic criteria for IBS by assessing the presence of individual symptoms rather than the disease itself. The instrument is able to distinguish between IBS and functional [[https://en.wikipedia.org/wiki/Functional_constipation|constipation]], functional [[https://en.wikipedia.org/wiki/Bloating|bloating]] and functional [[https://en.wikipedia.org/wiki/Diarrhea|diarrhea]].\\

===== Scoring =====
The Rome III IBS Diagnostic Questionnaire contains 26 items assessing the frequency of bowel complaints (i.e. recurrent abdominal pain or uncomfortable sensations not described as pain) in the last 3 months, with onset at least 6 months, associated with 2 or more of the following:
  * Improvement of pain/discomfort as a result of defecation; and/or
  * Onset associated with a change in frequency of stool; and/or
  * Onset associated with a change in form (appearance) of stool

===== Validity =====

  * Factor analysis confirms consistent clusters of symptoms corresponding to IBS; symptom-based criteria agree reasonably well (sensitivity, 0.4-0.9) with clinical diagnoses made by experienced clinicians; and patients with a clinical diagnosis of IBS who fulfill Rome II criteria have greater symptom severity and poorer quality of life than patients with a clinical diagnosis of IBS who do not fulfill Rome criteria. There are no consistent differences in sensitivity or specificity between Manning, Rome I, and Rome II. Both study types support the validity of symptom-based IBS criteria((Whitehead WE and Drossman DA (2010). Validation of symptom-based diagnostic criteria for irritable bowel syndrome: a critical review. Am J Gastroenterol. 105(4):814-20)).
  * Tests of Rome III are needed. However, one study comparing Rome II and Rome III criteria for IBS and its subtypes (IBS-C, D, M) within the same patient cohort (Female patients (n=148) with Rome II defined IBS showed excellent agreement (86.5%, κ=0.79), and the behavior of these patients were similar in terms of subtype prevalence and stability over a 1-year period((Dorn SD et al. (2009) Irritable bowel syndrome subtypes defined by Rome II and Rome III criteria are similar. J Clin Gastroenterol 43:214–220)).

===== Variables =====

| **Questions English**                                                                                                                                 | **Questions Dutch**                                                                                                                                 | **Code**                     | **Variable**  | **Assessment**                                                                                            | **Age**  |
| How often did you have abdominal pain or an unpleasant feeling in your abdomen in the past 3 months?                                                  | Hoe vaak had u in de afgelopen 3 maanden last van buikpijn of van een vervelend gevoel in uw buik?                                                  | rome3_discomfort_adu_q_01    | ROME1         | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| For women: did you have this unpleasant feeling in your belly only during your menstruation and not at other times?                                   | Voor vrouwen: had u alleen tijdens uw menstruatie last van dit vervelende gevoel in uw buik of van deze buikpijn en niet op andere momenten?        | rome3_discomfort_adu_q_02    | ROME2         | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| Have you had this unpleasant feeling in your abdomen or this abdominal pain for 6 months or longer?                                                   | Hebt u dit vervelende gevoel in uw buik of deze buikpijn al 6 maanden of langer?                                                                    | rome3_discomfort_adu_q_03    | ROME3         | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| How long have you had an unpleasant feeling in the abdomen or abdominal pain (in years)                                                               | Hoe lang een vervelend gevoel in de buik of buikpijn (in jaren)                                                                                     | rome3_discomfort_adu_q_03_a  | ROME3A        | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| How long have you had an unpleasant feeling in the abdomen or abdominal pain (in months)                                                              | Hoe lang een vervelend gevoel in de buik of buikpijn (in maanden)                                                                                   | rome3_discomfort_adu_q_03_b  | ROME3B        | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| How often did this unpleasant feeling in your abdomen or abdominal pain improve or disappear after bowel movement?                                    | Hoe vaak verminderde of verdween dit vervelende gevoel in uw buik of deze buikpijn na de ontlasting?                                                | rome3_discomfort_adu_q_04    | ROME4         | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| Did you have more frequent bowel movements after this unpleasant feeling in your abdomen or abdominal pain started?                                   | Had u, nadat dit vervelende gevoel in uw buik of deze buikpijn begon, vaker ontlasting?                                                             | rome3_discomfort_adu_q_05    | ROME5         | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| Did you have less frequent bowel movements after this unpleasant feeling in your abdomen or abdominal pain started?                                   | Had u, nadat dit vervelende gevoel in uw buik of deze buikpijn begon, minder vaak ontlasting?                                                       | rome3_discomfort_adu_q_06    | ROME6         | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| Were the stools softer or thinner after this unpleasant feeling in your abdomen started?                                                              | Was de ontlasting dunner of zachter nadat dit vervelende gevoel in uw buik of deze buikpijn begon?                                                  | rome3_discomfort_adu_q_07    | ROME7         | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| How often did you have harder stools after this unpleasant feeling in your abdomen or abdominal pain started?                                         | Hoe vaak had u, nadat dit vervelende gevoel in uw buik of deze buikpijn begon, last van hardere ontlasting?                                         | rome3_stool_adu_q_08         | ROME8         | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| How often did you have fewer than 3 (0-2) bowel movements a week in the past 3 months?                                                                | In de afgelopen 3 maanden, hoe vaak had u  minder dan 3 keer (0-2 keer) ontlasting per week?                                                        | rome3_stool_adu_q_09         | ROME9         | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| In the past 3 months, how often did you have hard or pellet-like stools?                                                                              | In de afgelopen 3 maanden, hoe vaak had u last van harde of keutelige ontlasting?                                                                   | rome3_stool_adu_q_10         | ROME10        | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| In the past 3 months, how often did you have to strain during bowel movements?                                                                        | In de afgelopen 3 maanden, hoe vaak moest u persen tijdens de stoelgang?                                                                            | rome3_stool_adu_q_11         | ROME11        | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| In the past 3 months, how often did you have the feeling that your intestines were not quite empty after bowel movements?                             | In de afgelopen 3 maanden, hoe vaak had u  na de stoelgang het gevoel dat uw darmen niet helemaal leeg waren?                                       | rome3_stool_adu_q_12         | ROME12        | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| In the past 3 months, how often did you have the feeling that your stools did not want to pass during bowel movements (i.e. were blocked)?            | In de afgelopen 3 maanden, hoe vaak had u het gevoel dat uw ontlasting tijdens de stoelgang niet wilde passeren (ofwel geblokkeerd werd)?           | rome3_stool_adu_q_13         | ROME13        | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| In the past 3 months, how often did you press on or around the anus or removed stools manually to complete bowel movements?                           | In de afgelopen 3 maanden, hoe vaak hebt u op of rond de anus gedrukt of ontlasting handmatig verwijderd om de stoelgang te voltooien?              | rome3_stool_adu_q_14         | ROME14        | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| Did one or more of the symptoms of constipation listed in ROME9 to ROME14 start more than 6 months ago?                                               | Zijn één of meer symptomen van obstipatie zoals genoemd in vraag ROME9 t/m ROME14, meer dan 6 maanden geleden begonnen?                             | rome3_stool_adu_q_15         | ROME15        | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| I the past 3 months, how often did you have thin, loose or watery stools?                                                                             | Hoe vaak had u in de afgelopen 3 maanden last van dunne, brijige of waterige ontlasting?                                                            | rome3_stool_adu_q_16         | ROME16        | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| Was at least three-quarters (3/4) of your stools thin, loose or watery in the past three months?                                                      | Was in de afgelopen 3 maanden minstens driekwart (¾) van uw ontlasting dun, brijig of waterig?                                                      | rome3_stool_adu_q_17         | ROME17        | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| Have you regularly had thin, loose or watery stools for longer than 6 months?                                                                         | Hebt u al langer dan 6 maanden regelmatig dunne, brijige of waterige ontlasting?                                                                    | rome3_stool_adu_q_18         | ROME18        | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| How often did you have intestinal gas or a swollen/hard belly in the past 3 months?                                                                   | Hoe vaak had u in de afgelopen 3 maanden last van gasvorming of een opgezette/harde buik?                                                           | rome3_gas_adu_q_19           | ROME19        | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| Did your symptoms of intestinal gas or a swollen/hard belly start more than 6 months ago?                                                             | Zijn uw symptomen van gasvorming of een opgezette/harde buik meer dan 6 maanden geleden begonnen?                                                   | rome3_gas_adu_q_20           | ROME20        | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| How often did you have an unpleasantly full feeling after a regular-sized meal in the past 3 months?                                                  | Hoe vaak had u in de afgelopen 3 maanden een onprettig vol gevoel na een maaltijd van normale omvang?                                               | rome3_meals_adu_q_21         | ROME21        | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| Have you had this bloated feeling after meals for longer than 6 months?                                                                               | Hebt u al langer dan 6 maanden last van dit onprettig volle gevoel na de maaltijd?                                                                  | rome3_meals_adu_q_22         | ROME22        | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| How often were you unable to finish a regular-sized meal in the past 3 months?                                                                        | Hoe vaak was u in de afgelopen 3 maanden niet in staat om een normale maaltijd volledig op te eten?                                                 | rome3_meals_adu_q_23         | ROME23        | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| Have you had this problem with eating a complete meal for longer than 6 months?                                                                       | Hebt u al langer dan 6 maanden last van dit onvermogen om een normale maaltijd volledig op te eten?                                                 | rome3_meals_adu_q_24         | ROME24        | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| How often did you have pain or a burning feeling in the centre of your abdomen, above your belly button, but not in the chest, in the past 3 months?  | Hoe vaak had u de afgelopen 3 maanden pijn of een branderig gevoel in het midden van de buik, boven uw navel, maar niet in de borst?                | rome3_pain_adu_q_25          | ROME25        | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
| Have you had this pain or burning feeling for longer than 6 months?                                                                                   | Hebt u al langer dan 6 maanden deze pijn of dit branderige gevoel?                                                                                  | rome3_pain_adu_q_26          | ROME26        | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]]  [[NEXT]] [[DEEP]]  | 18+      |
| To what extent did your abdominal complaints hamper your normal activities (both work outside the home and household chores) in the past 6 months?    | In welke mate hebben buikklachten u de afgelopen 6 maanden belemmerd bij uw normale werkzaamheden (zowel werk buitenshuis als huishoudelijk werk)?  | rome3_pain_adu_q_27          | ROME27        | [[2A Questionnaire 2|2A]] [[3A Questionnaire 1|3A]] [[4A Questionnaire Health 3| 4A]] [[NEXT]] [[DEEP]]   | 18+      |
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