{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T22:10:08Z","timestamp":1777759808965,"version":"3.51.4"},"reference-count":19,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T00:00:00Z","timestamp":1777334400000},"content-version":"vor","delay-in-days":27,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2022YFC2504001"],"award-info":[{"award-number":["2022YFC2504001"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2022YFC2504006"],"award-info":[{"award-number":["2022YFC2504006"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Neurogastroenterology Motil"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>This study aims to systematically investigate the symptom spectrum of Chinese constipated patients, and to evaluate the diagnosis performance and clinical applicability of Rome IV criteria in Chinese.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Unselected outpatients (aged \u2265\u200916\u2009years) who had a self\u2010diagnosis of \u201cconstipation\u201d were enrolled and administered the Rome IV questionnaire. Data on demographics, stool forms, defecation symptoms and frequencies were collected. Healthy controls (aged \u2265\u200916\u2009years) were recruited to gather their demographics and defecation pattern data. The consistency of Rome IV criteria with respondents' self\u2010assessment was evaluated and modifications were proposed based on newly\u2010established thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 6364 respondents with self\u2010diagnosis of constipation and 1432 healthy controls were included. Among constipated individuals, the most prevalent bowel symptoms matched the six Rome IV diagnostic symptom indicators. However, Rome IV criteria manifested poor consistency with self\u2010assessment (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.58,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). To minimize the discrepancy between Rome IV criteria and self\u2010assessment, we established clinically meaningful thresholds using the 90th percentile of symptom distribution in healthy controls. We made a comparative analysis and found that the diagnostic approach requiring \u2265\u20092 abnormal symptoms had the highest consistency (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.85,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The standard Rome IV criteria demonstrated suboptimal performance in diagnostic consistency within the Chinese population. Our modified 2\u2010symptom diagnostic framework significantly enhanced all performance metrics, offering a more tailored approach for constipation diagnosis in the Chinese population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nmo.70323","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T02:52:00Z","timestamp":1777431120000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Optimization of Rome\n                    <scp>IV<\/scp>\n                    Diagnostic Criteria Based on Symptom Spectrum in the Chinese Constipated Patients"],"prefix":"10.1111","volume":"38","author":[{"given":"Qing","family":"Huang","sequence":"first","affiliation":[{"name":"Chongqing Medical University  Chongqing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yurong","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology The Affiliated Hospital of Guizhou Medical University  Guiyang China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S. R.","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology  Wuhan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuen","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology  Wuhan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology  Wuhan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3694-2126","authenticated-orcid":false,"given":"Xiaohua","family":"Hou","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Union Hospital, Tongji Medical College, Huazhong University of Science and Technology  Wuhan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology The Affiliated Hospital of Guizhou Medical University  Guiyang China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,4,28]]},"reference":[{"issue":"8","key":"e_1_2_11_2_1","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1016\/S2468-1253(21)00111-4","article-title":"Global Prevalence of Functional Constipation According to the Rome Criteria: A Systematic Review and Meta\u2010Analysis","volume":"6","author":"Barberio B.","year":"2021","journal-title":"Lancet Gastroenterology & Hepatology"},{"key":"e_1_2_11_3_1","first-page":"532734","article-title":"Epidemiology Characteristics of Constipation for General Population, Pediatric Population, and Elderly Population in China","volume":"2014","author":"Chu H.","year":"2014","journal-title":"Gastroenterology Research and Practice"},{"issue":"47","key":"e_1_2_11_4_1","doi-asserted-by":"crossref","first-page":"13368","DOI":"10.3748\/wjg.v21.i47.13368","article-title":"Epidemiological Study of Elderly Constipation in Beijing","volume":"21","author":"Zhang M.","year":"2015","journal-title":"World Journal of Gastroenterology"},{"issue":"5","key":"e_1_2_11_5_1","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1053\/j.gastro.2020.02.016","article-title":"Are the Rome Criteria a Sound Standard for Gastrointestinal Disorders Worldwide?","volume":"158","author":"Verne G. N.","year":"2020","journal-title":"Gastroenterology"},{"issue":"6","key":"e_1_2_11_6_1","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1053\/j.gastro.2016.03.035","article-title":"Rome IV\u2010Functional GI Disorders: Disorders of Gut\u2010Brain Interaction","volume":"150","author":"Drossman D. A.","year":"2016","journal-title":"Gastroenterology"},{"issue":"5","key":"e_1_2_11_7_1","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1111\/j.1365-2036.2006.03238.x","article-title":"Chronic Constipation: A Survey of the Patient Perspective","volume":"25","author":"Johanson J. F.","year":"2007","journal-title":"Alimentary Pharmacology & Therapeutics"},{"issue":"1","key":"e_1_2_11_8_1","first-page":"274","article-title":"The Defecation Habits of People in Central China: A Cross\u2010Sectional Survey and a Literature Review","volume":"32","author":"Zhu S. 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