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Chapter 3 58 With regard to baseline levels of GI symptom severity (assessed by the GSRS, as baseline GSRS-IBS data were not available), it can be noted that Rome III-negative patients had slightly lower baseline scores for abdominal pain. Nevertheless, after correction for multiple comparisons, this did not reach statistical significance nor did other GI symptoms differ significantly between the groups at baseline. In terms of general anxiety, depression, and general quality of life scores, no baseline differences were observed between Rome III-positive and -negative patients ( Table 3.2 ). Moreover, the proportion of patients that had been recruited for the cohort from the primary care setting did not differ between Rome III-positive and -negative patients ( Table 3.2 ). In addition, the distribution in baseline IBS-subtypes did not differ between Rome III- positive and -negative patients ( Table 3.2 ). Symptom evolution over time Table 3.3 shows the evolution of clinical characteristics and symptoms over time by pairwise comparisons between baseline and follow-up measurements. Overall, improvements in GI symptom severity (assessed by the GSRS, as baseline GSRS-IBS data were not available), general quality of life, and general anxiety and depression over a five-year period were small and did not reach significance in patients that still met the Rome III-diagnostic criteria at follow-up. Symptom severity for abdominal pain, diarrhea, constipation, and indigestion did improve significantly over time in the Rome III-negative patients, although they still had ‘low to moderate’ levels of symptoms after five years, with a median abdominal pain GSRS score of 2.33 (IQR=1.33-3.00), and a median indigestion GSRS score of 2.88 (IQR=2.25-3.94). However, similar to the Rome III- positive patients, the Rome III-negative patients did not improve significantly in quality of life during the follow-up period. In addition, their comorbid depression scores were relatively unaltered. With regard to IBS subtype based on predominant bowel habit, Supplementary Figure S3.1 illustrates the proportion of IBS subtypes at baseline and at follow-up. Sixty-two (55.4%) out of 112 Rome III-positive patients had changed IBS-subtype during the follow-up period. In Supplementary Figure S3.2 , the within-patient subtype changes from baseline to follow-up are shown. IBS-D appeared the most stable subtype (72.5% of Rome III-positive unchanged), whereas IBS-M and IBS-C were least stable (76,6% and 60.9% of Rome III-positive changed respectively).