Influence of the requirement for abdominal pain in the diagnosis of irritable bowel syndrome with constipation (IBS-C) under the Rome IV criteria using data from a large Japanese population-based internet survey

Background

Rome III was revised to Rome IV in May 2016. One important change in the Rome IV criteria is that abdominal pain must be present for a diagnosis of irritable bowel syndrome (IBS). Under Rome III, in contrast, patients with abdominal discomfort only could be diagnosed with IBS, but these cases under Rome IV are now classified as unspecified functional bowel disorder (FBD). In a simple comparison of Rome III and Rome IV, it is unclear whether this difference reflects the influence of symptomatic frequency or the presence of abdominal pain. In particular, the influence of abdominal pain restriction on the diagnosis of IBS with predominant constipation (IBS-C) in the Rome IV criteria is largely unknown.

Methods

We reclassified subjects from a Japanese internet survey experiencing abdominal pain or discomfort at least one day each week as surrogate Rome III IBS-C subjects. Among them, we then reclassified subjects experiencing abdominal pain as surrogate Rome IV IBS-C subjects and subjects not experiencing abdominal pain as surrogate Rome IV FBD subjects. Symptoms were quantified and compared between the two groups.

Results

The surrogate Rome IV IBS-C subjects felt a significantly higher degree of anxiety in their daily lives (p?<?0.001) compared with the surrogate Rome IV FBD subjects. The combined female and 20–49?years surrogate Rome IV IBS-C subjects felt a higher degree of anxiety in their daily lives (p?<?0.05) than the respective Rome IV FBD subjects.

Conclusions

These results suggest that female IBS-C patients aged 20–49?years with abdominal pain in Rome IV have more anxiety than those without abdominal pain in Rome III. Changes in the diagnostic criteria from Rome III to Rome IV will better identify candidates for the biopsychosocial approach.

Trial registration

Although this survey was an anonymous internet survey, we obtained informed consent for the study as an online response. The disclosure of this study was approved by the Ethics Committee of Tohoku University Graduate School of Medicine (approval number: 2015–1-405).

     

Planting the seed of Rome

The paper summarises some of the results of a long term project carried out by the author on charred macroremains from several key sequences in Rome and its broader hinterland dating from between the 9th and the 6th cent. B.C. This is the period that witnesses major changes in the structure of the settlement, in its social complexity and in its economic processes leading to formation of the state and urbanisation. Building upon recent work analysing the relationship between the emergence of social complexity and crop processing (as seen through the macroremains), possible evidence for structural changes in Roman archaic society are investigated, with particular attention to issues such as the centralisation of food storage and processing or the organisation of redistribution. Studies of this kind may well offer a different perspective on the beginnings of Rome, counterbalancing the traditional emphasis on textual evidence and burial analysis. Received September 2, 2001 / Accepted May 13, 2002     

The vascular flora of Rome

The aim of this paper is to document plant diversity in the metropolitan area of Rome (Italy) by providing a comprehensive inventory of the present-day vascular flora and an overview of its composition and species diversity. We compiled the floristic catalogue by including all vascular plant entities that occur spontaneously within the administrative boundaries of the Rome municipality. The data, which were gathered from extensive field surveys, from a broad review of the literature and from herbaria records, were updated and integrated in a comprehensive account. The inventory of the flora of metropolitan Rome lists 1649 entities, from 139 families and 677 genera. The flora contains 228 taxa that are non-native to the Italian flora, 81 of which are established in the study area. The overview of flora reveals a remarkable species diversity and outlines the main characteristics of the flora of Rome, which may be summarized as (1) a large number of taxa of high conservation value which occur in remnants of near-natural vegetation, (2) the loss or decline of some species, particularly of native freshwater plants, (3) a remarkably high native species richness within the urban area, which includes many native woody species and (4) a rich ruderal flora, prevalently composed of native species that are well adapted to human disturbance, along with a variety of taxa of non-native or uncertain origin. The large set of data and the overview presented in this paper represent a fundamental framework for future research and for the conservation of plant diversity in metropolitan Rome.     

The Colosseum's use and state of abandonment as analysed through its flora

Over the past four centuries, different lists of the flora of the Colosseum have been published (Jatrologismi sive medicae observationes quibus additus est in fine Plantarum Amphitheatralium Catalogus. Typis Dominici Marciani, Rome, p. 15; Enumeratio plantarum sponte nascentium in ruderibus Amphitheatri Flavii. Typis Pauli Salviucci et filii, Rome, p. 80; Flora of the Colosseum of Rome. London. p. 230; Florula del Colosseo. Atti Accademia Pontificia Nuovi Lincei 28, 20,7; 29, 33; 30, 8; 31, 13; Ann. Bot. (Roma) XXIII (fasc. 3) (1951) 393; Webbia 56(2) (2001) 321). The rich plant colonization (684 species, as the sum of the various lists) appears to be due to the great variety of habitats in the monument and to its state of abandonment. The comparison among the different floras allows a quantitative estimate of the following general changes to be determined: a gradual yet notable decrease of typical elements of mature dynamic stages; a constant decrease in species related to grazing and animal droppings, as well as in weeds from cultivated fields; and a constant increase of widely distributed and alien species, indicators of a different but ever stronger impact of man on the area.     

Anthropological, demographic and socioeconomic characteristics of irritable bowel syndrome

Irritable bowel syndrome (IBS) in one of the most frequent functional gastrointestinal disorders (FGIDs) with a prevalence in 10 to 20%, of cases in some developed countries. The Rome Foundation has drawn up Rome III criteria, diagnostic questionnaires and scoring algorithm for FGIDs, applicable in clinical practice and population studies. The aim of this research is to determine the presence of IBS in Osjecko-baranjska County and the effect of anthropometric, demographic and socioeconomic factors. 703 subjects selected in the systematic sample filled in the Rome III diagnostic questionnaire for IBS. Prevalence of IBS was recorded in 29.16%, in men in 21.39%, and in women in 36.69% of cases, anxiety and depression in 26.34% and 25.85%. Persons suffering from IBS were on average shorter, weighed less and had a lower BMI than persons not showing signs of IBS. Women have 2.101 times greater chance of risk of IBS, and with an increase in the number of members in the household the risk of IBS increases 1.139 times. Rome III survey questionnaire is an acceptable method for diagnosing IBS and identifying persons showing signs of structural changes in order to provide further treatment.     

Tanganyikacypridopsis gen.n. (Crustacea, Ostracoda) from Lake Tanganyika

A new genus of freshwater ostracods, Tanganyikacypridopsis gen.n., is established to include the species Potamocypris depressa Kiss, 1959, Cypridopsis calcarata Rome, 1962 and Cypridopsis anomala Rome, 1962, all from Lake Tanganyika. The genus is related to Sarscypridopsis McKenzie, 1977 and Plesiocypridopsis (Rome, 1965), mainly because of its hemipenis anatomy, and is believed to be endemic to Lake Tanganyika.     

Prophecy and the Performance of Metaphor

In 1975 the movement known as the Catholic Charismatic Renewal held its annual conference in Rome for the first time. In this symbolically charged setting, "prophecy" was uttered by prophets from The Word of God, the largest and most highly organized of charismatic covenant communities. These Rome prophecies were deemed a direct message from God and revealed that the role of the Charismatic Renewal was to protect the church. The prominent metaphor in subsequent prophetic utterances was that of the alliance of covenant communities as a "bulwark" for the church against the apocalyptic onslaught of the forces of darkness.     

Adaptation to past malarial endemia and susceptibility to common diseases in modern populations: a study of adenosine deaminase and MN blood group genetic polymorphisms

We carried out a study of adenosine deaminase (ADA) and MN blood group genetic polymorphisms in relation to past malarial morbidity in Sardinia and in relation to susceptibility to allergic asthma (a Th2 disorder) and Crohn's disease (a Th1 disorder) in the population of Rome. Eight hundred and eight schoolchildren, aged 7--14 years from 14 Sardinian villages located in the central area of the island, were considered. One hundred and twenty-two children with allergic asthma and 39 adult patients with Crohn's disease from the population of Rome were also studied. The data suggest an interaction between the two systems concerning resistance/susceptibility, both to malaria and to the diseases considered. In Sardinia, the frequency of the *L(M)/ADA*2 gametic type is negatively correlated with past malarial endemia, suggesting an increased susceptibility to malaria leading to its decrease in areas with high malarial endemia. In Rome, this gametic type is correlated negatively to allergic asthma and positively to Crohn's disease, suggesting a protective effect against allergic asthma and increased susceptibility to Crohn's disease.     

Isotopic evidence for age-related immigration to imperial Rome

Oxygen stable isotope ratios (delta(18)O) have been determined in carbonate in paired first and third molar teeth from individuals (N = 61) who lived in the town of Portus Romae ("Portus") and who were buried in the necropolis of Isola Sacra (First to Third centuries AD) near Rome, Italy. We compare these analyses with data for deciduous teeth of modern Roman children. Approximately one-third of the archaeological sample has first molar (M1) values outside the modern range, implying a large rate of population turnover at that time, consistent with historical data. Delta (18)O(ap) values suggest that a group within the sample migrated to the area before the third molar (M3) crown had completely formed (i.e., between 10 and 17.5 years of age). This is the first quantitative assessment of population mobility in Classical antiquity. This study demonstrates that migration was not limited to predominantly single adult males, as suggested by historical sources, but rather a complex phenomenon involving families. We hypothesize that migrants most likely came from higher elevations to the East and North of Rome. One individual with a higher delta(18)O value may have come (as a child) from an area isotopically similar to North Africa.     

Placental alkaline phosphatase polymorphism in some Italian populations

Summary Gene frequencies of Pl alleles for alkaline phosphatase of human placenta have been studied in the populations of Rome and L'Aquila. The latter represents a mixed sample of descendants from ancient Italic populations which in the last 20 centuries have been free from significant immigratory influx.The Pl gene frequencies in the two Italian populations are significantly different, the Pl ^s ₁ frequency being lower and Pl ^f ₁ frequency higher in the population of L'Aquila as compared to the population of Rome. The gene frequency of the 3 common Pl alleles in the population of Rome are quite similar to that found in some Northern-European populations. The frequency of the Pl ^s ₁ allele observed in the population of L'Aquila is the lowest (and correspondingly that for Pl ^f ₁ allele is the highest) amongst all populations studied so far.     

The historical ecological footprint: From over-population to over-consumption

The ecological risk from over-population has been recognized since Malthus (1798). GDP growth per capita in agriculture disproved his pessimism but, since the Club of Rome and its case on Limits to Growth more recently there has been concern that there is a parallel risk from such growth in terms of ecological footprints (EF). Authors have developed a GDP/EF correlation function and calculated the ecological footprint (EF) from 10,000 B.C. till 1960, using historical statistics, with the method of backcasting (Brandes and Brooks, 2005).¹ In all major indicators growth patterns have been dominating, not only since the industrial revolution, but in the known history of mankind. From data since 1961, we calculate the correlation between GDP and the ecological footprint and have been able to determine long time data series of population, GDP, biocapacity and EF. Our findings are first: the main driver of growth and environmental degradation is not population per se, but consumption patterns and levels multiplied by the number of consumers, especially in developed economies, as the I = PAT equation recognized (Ehrlich and Holdren, 1971). In fact, as we approach to today, population, which used to be the key driver to growth and environmental degradation, becomes the least important driver, especially in the last two decades. Second: change is not incremental or linear as assumed in much mainstream economics: in line with Schumpeter's bunching and swarming and it jumps and leaps asymmetrically, as in our finding of such a leap (the 7th) between the 1930s and 1970s. Third: the dominant paradigm legitimizing growth (from the late 18th century) while already challenged by many since the Club of Rome and other reports should be revisited in terms of the concept of ‘fullness’ in the sense that while the earth in 1776 was roughly 10 per cent full, by 2008 this figure was over 150 per cent.     

A study of cremated human remains from an urn field dating to the final phase of the Bronze Age, found at “Le Caprine” (Guidonia, Rome, Italy 10th-9th century B.C.)

In this paper cremated human remains from an urn field dating from the final phase of the Bronze age (Guidonia, Rome, Central Italy) were studied. The aim of this study was to identify the minimal number of individuals for grave and cremation patterns. The results show as the ways in which the cremations were carried out were archaic in all the elements that made them up.     

The forgotten donkey's history. Remarks on African wild asses of the Giardino Zoologico in Rome and their relevance for Equus africanus (von Heuglin & Fitzinger, 1866) taxonomy and conservation

This paper reviews the history of African wild asses in the Giardino Zoologico of Rome, highlighting their relevance to taxonomy of Equus africanus (von Heuglin & Fitzinger, 1866). Specifically, it is demonstrated that the so-called Munich/Catskill stock of African wild ass originated from three animals imported in Rome from Eritrean Danakil in August 1932. Available evidence suggests that contrary to some recent statements, these ‘wild’ asses were not related to the Nubian wild ass and are better considered as the result of some intergradations between Somali wild asses and local Danakil donkeys.     

Island biogeography of urban insects: tenebrionid beetles from Rome tell a different story

Tenebrionid beetle records from 55 sites in urban Rome (Italy) were used to study the influence of structural parameters (area, isolation, forest cover, and shape) of green spaces on species richness and extinction trends. In line with biogeographical predictions, species richness correlated positively with area size of green spaces, extinction was enhanced by isolation and hindered by area size, but, in contrast with common findings, forest extent had a negative impact on tenebrionid persistence. This is explained by the fact that most of tenebrionid species from Rome are associated with open habitats typical of the landscape that characterized the study area before modern urbanization. In contrast with results obtained in other studies of urban ecology, distance to city centre (which expresses the urban–rural gradient) was never recovered as an important correlate of tenebrionid richness or extinction, which may be explained by the fact that tenebrionids include both urban avoider and urban adapter species. These results warn against making generalizations on urban diversity patterns and conservation strategies without reference to past land-use and species characteristics.     

Characteristics of Yersinia spp. isolated from wild and zoo animals

Thirteen strains of Yersinia spp. were isolated at the Rome zoo and at Castelporziano, a game preserve near Rome. The strains were tested for calcium dependency, autoagglutination, heat-stable toxin production, 50% minimum lethal dose in mice (LD50), pyrazinamidase activity and content of plasmids by electrophoresis in agarose gel. The former three tests were negative for all strains, the LD50 was always greater than or equal to 1 X 10(7.6) CFU/ml and pyrazinamidase activity was positive for all strains. Electrophoresis revealed the presence of two plasmids of 27 and 66 megadaltons (MDa) in the two strains of Y. enterocolitica of serotype 027 isolated from animals in the zoo. The two strains of the same species and serotype, isolated from wild animals harboured a 42-MDa plasmid. A small plasmid of 2 MDa was found in two strains of Y. enterocolitica of serotype 07.8 from two subsequent samples of a zoo animal.     

Fatal infection with Taenia martis metacestodes in a ring-tailed lemur (Lemur catta) living in an Italian zoological garden

A case of fatal infection caused by larval forms of Taenia martis in a ring-tailed lemur (Lemur catta) living in the Rome zoological garden is described. The animal, living in a semi-natural pen with other 15 conspecific individuals and being fed with fresh fruit and vegetables, yoghurt and eggs, was transported to the Istituto Zooprofilattico of Rome for post-mortem examination. The anamnesis included, ten days before the death, apathy, lack of appetite, abdominal distension and diarrhoea. A severe exudative fibrinous-purulent peritonitis with numerous adhesions between the abdominal wall and the bowel loops was detected. After intestine removal, two free and viable, 4 cm long, whitish, leaf-like parasitic forms were pinpointed. Macroscopic examination of the two parasites allowed their identification as larval stages of cestodes, identified via molecular analysis as T. martis metacestodes. This report represents the first record of T. martis infection in the host species and in a zoological garden and for the pathological relevance of the infection.     

XI National Congress of the Italian Cell Culture Association (AICC) Rome, October 29–31, 1990

XI National Congress of the Italian Cell Culture Association (AICC)Rome, October 29–31, 1990