Zsa Zsa Weerts

General discussion 241 10 decrease of approximately 6% compared to population prevalence rates on the basis of the Rome III criteria. 11 Consequently, clinicians need to be aware of the fact that a significant percentage of patients presenting with IBS symptoms, does not fulfill the more restrictive Rome IV criteria, though they are in need for therapy, similar to patients fulfilling the criteria. Under the new Rome IV criteria, the majority of patients would rather be categorized as having functional constipation, functional diarrhea, functional abdominal bloating/distention or unspecified bowel disorder. The diagnostic confusion may lead to delay or lack of appropriate treatment. Furthermore, patients who are Rome IV negative are excluded from participation in clinical trials on novel therapeutic strategies that may otherwise benefit them. Although this is directly related to the update in criteria, we showed that even patients who did no longer fulfill the preceding Rome III criteria for IBS after a 5-year follow-up period still presented with moderate GI symptoms and had comparable scores of impaired quality of life and general well-being as those who still fulfilled the criteria ( chapter 3 ). Failing to treat symptoms that hamper quality of life and affect patients’ everyday functioning may eventually result in increased health-associated costs. We therefore pragmatically advise that patients who present with functional GI symptoms, but do not fulfill the diagnostic Rome IV criteria, should still be managed as having a functional GI disorder. Diagnosing IBS in daily practice is complicated by it often being a diagnosis by exclusion. 12 As a consequence, a large proportion of patients undergo numerous diagnostic investigations to exclude organic disorders, even though studies have shown that the yield of these is rather low and not substantiated or evidence-based. 12,13 The diagnostic work-up of IBS often is redundant, with significant costs and challenges to the financially restrictive healthcare system. The high prevalence of IBS, the associated frequent usage of healthcare resources and loss in work productivity ( i.e. absenteeism and presenteeism) result in a considerable global impact on society and associated economic burden. 14 The challenging (re)search for better therapies Another major contributing factor to the substantial socioeconomic burden is the limited efficacy of most therapeutic modalities for IBS. Neither low-cost traditional, nor new and more costly pharmacological agents for IBS have been able to provide more than 8-20% therapeutic gain over placebo. 15 Novel therapeutic strategies that not only provide more global relief, but are also cost-effective are therefore urgently needed.