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Rome Foundation-Asian working team report: Asian functional gastrointestinal disorder symptom clusters
  1. Kewin Tien Ho Siah1,2,
  2. Xiaorong Gong3,4,
  3. Xi Jessie Yang5,
  4. William E Whitehead6,
  5. Minhu Chen4,
  6. Xiaohua Hou7,
  7. Nitesh Pratap8,
  8. Uday C Ghoshal9,
  9. Ari F Syam10,
  10. Murdani Abdullah10,
  11. Myung-Gyu Choi11,
  12. Young-Tae Bak12,
  13. Ching-Liang Lu13,
  14. Sutep Gonlachanvit14,
  15. Chua Seng Boon15,
  16. Fan Fang16,
  17. Pui Kuan Cheong16,
  18. Justin C Y Wu16,
  19. Kok-Ann Gwee2
  1. 1 Division of Gastroenterology & Hepatology, University Medicine Cluster, National University Hospital, Singapore
  2. 2 Department of Internal Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  3. 3 Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
  4. 4 Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yet-Sen University, Guangzhou, China
  5. 5 Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan, USA
  6. 6 Centre for Functional GI and Motility Disorders, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  7. 7 Department of Gastroenterology and Hepatology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  8. 8 Asian Institute of Gastroenterology, Hyderabad, India
  9. 9 Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
  10. 10 Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia/Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  11. 11 Department of Internal Medicine, The Catholic University of Korea, Seoul, South Korea
  12. 12 Department of Gastroenterology, Korea University Guro Hospital, Seoul, South Korea
  13. 13 Division of Gastroenterology, Taipei Veterans General Hospital, National Yang-Ming University Taipei, Taiwan National Yang-Ming University Taipei, Taipei, Taiwan
  14. 14 Department of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand
  15. 15 Ipoh Gastro Centre, Perak, Malaysia
  16. 16 Department of Medicine and Therapeutics, Institute of Digestive Disease, The Chinese University of Hong Kong, Sha Tin, Hong Kong
  1. Correspondence to Kok-Ann Gwee, Department of Internal Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore; kok_ann_gwee{at}


Objective Functional gastrointestinal disorders (FGIDs) are diagnosed by the presence of a characteristic set of symptoms. However, the current criteria-based diagnostic approach is to some extent subjective and largely derived from observations in English-speaking Western patients. We aimed to identify latent symptom clusters in Asian patients with FGID.

Design 1805 consecutive unselected patients with FGID who presented for primary or secondary care to 11 centres across Asia completed a cultural and linguistic adaptation of the Rome III Diagnostic Questionnaire that was translated to the local languages. Principal components factor analysis with varimax rotation was used to identify symptom clusters.

Results Nine symptom clusters were identified, consisting of two oesophageal factors (F6: globus, odynophagia and dysphagia; F9: chest pain and heartburn), two gastroduodenal factors (F5: bloating, fullness, belching and flatulence; F8 regurgitation, nausea and vomiting), three bowel factors (F2: abdominal pain and diarrhoea; F3: meal-related bowel symptoms; F7: upper abdominal pain and constipation) and two anorectal factors (F1: anorectal pain and constipation; F4: diarrhoea, urgency and incontinence).

Conclusion We found that the broad categorisation used both in clinical practice and in the Rome system, that is, broad anatomical divisions, and certain diagnoses with long historical records, that is, IBS with diarrhoea, and chronic constipation, are still valid in our Asian societies. In addition, we found a bowel symptom cluster with meal trigger and a gas cluster that suggests a different emphasis in our populations. Future studies to compare a non-Asian cohort and to match to putative pathophysiology will help to verify our findings.

  • functional gastrointestinal disorders
  • factor analysis
  • asia
  • digestive symptoms

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  • Contributors KTHS: study conceptualisation, planning, supervision, data analysis and manuscript writing; XG, XJY, MC, XH, NP, UCG, AFS, MA, M-GC, Y-TB, C-LL, SG, CSB, FF, PKC and JCYW: planning, supervision, data analysis and manuscript review; WEW: study conceptualisation and planning of the manuscript; K-AG: study conceptualisation, planning and manuscript writing.

  • Funding Authors thank Abbott and Janssen Pharmaceutical for unconditional financial support towards the activities of the study through Asian Neurogastroenterology and Motility Association.

  • Competing interests KAG has received research grants from Abbott Laboratories and Janssen Pharmaceuticals, speaking honorarium from Abbott Laboratories, Janssen Pharmaceuticals and Boehringer Ingelheim International GmbH and is on the scientific advisory board of Danone Research. The other authors have no conflict of interest to declare.

  • Patient consent Obtained.

  • Ethics approval Ethical Review Board of each country.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All available data can be obtained by contacting the corresponding author.

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