Elsevier

The Journal of Pediatrics

Volume 161, Issue 4, October 2012, Pages 615-620.e1
The Journal of Pediatrics

Original Article
Functional Defecation Disorders in Children: Comparing the Rome II with the Rome III Criteria

https://doi.org/10.1016/j.jpeds.2012.03.060Get rights and content

Objectives

To evaluate the prevalence of pediatric functional defecation disorders (FDD) using the Rome III criteria and to compare these data with those obtained using Rome II criteria.

Study design

A chart review was performed in patients referred to a tertiary outpatient clinic with symptoms of constipation and/or fecal incontinence. All patients received a standardized bowel questionnaire and physical examination, including rectal examination. The prevalence of pediatric FDD according to both Rome criteria sets was assessed.

Results

Patients with FDD (n = 336; 61% boys, mean age 6.3 ± 3.5 SD) were studied: 39% had a defecation frequency ≤2/wk, 75% had fecal incontinence, 75% displayed retentive posturing, 60% had pain during defecation, 49% passed large diameter stools, and 49% had a palpable rectal fecal mass. According to the Rome III criteria, 87% had functional constipation (FC) compared with only 34% fulfilling criteria for either FC or functional fecal retention based on the Rome II definitions (P < .001). Of the patients with a rectal fecal mass, 95% would also have been correctly identified as having FC without a rectal examination. Twenty-nine patients (11%) fulfilled the criteria for functional nonretentive fecal incontinence according to both the Rome II and Rome III criteria.

Conclusion

The pediatric Rome III criteria for FC are less restrictive than the Rome II criteria. The Rome III criteria are an important step forward in the definition and recognition of FDD in children.

Section snippets

Methods

The study consisted of a retrospective chart review. No consent was needed as the questionnaire, physical examination, and diary were part of the standard workup as per the established department protocol.

Between January 2007 and December 2009, otherwise healthy children (0-18 years old) with complaints of constipation and/or FI were referred by general practitioners, school physicians, and pediatricians to the outpatient clinic of a tertiary academic hospital. Children with systemic diseases

Results

Over a 3-year period, 336 consecutive patients (61% boys, mean ± SD age 6.3 ± 3.5 years) referred for evaluation of a functional defecation disorder were included in this study. Clinical characteristics and symptoms of all patients are shown in Table I. FI and retentive posturing behavior were the most prevalent symptoms (both 75%), followed by pain during defecation (60%). The number of FI episodes varied from 0-45 times per week. Abdominal pain was present in 75% of all patients, with 68% of

Discussion

Our study shows that FC is recognized and diagnosed more frequently by using the “new” Rome III criteria compared with the “old” Rome II criteria. Because the only change from Rome II to Rome III criteria with respect to FNRFI included the decrease from 3 to 2 months in required symptom duration, there was no difference in recognition of this entity using the new and old criteria.

In accordance with a study by Boccia et al,12 which showed a greater applicability of the PACCT criteria (which

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    The authors declare no conflicts of interest.

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