{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:53:10Z","timestamp":1781632390291,"version":"3.54.5"},"reference-count":40,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T00:00:00Z","timestamp":1769212800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T00:00:00Z","timestamp":1771286400000},"content-version":"vor","delay-in-days":24,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"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"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Gastroenterol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Bloating\/abdominal distension is a common gastrointestinal symptom. However, the abnormal endoscopy results associated with bloating\/abdominal distension and its influencing factors in outpatients remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter cross-sectional study was conducted in 100 tertiary care hospitals nationwide and involved the use of a mobile applet to complete questionnaires to record the medical history of outpatients with bloating\/distension. This was followed by an analysis of the upper and lower gastrointestinal endoscopic detection results and the factors influencing them. Finally, the transition from the Rome III to Rome IV criteria was explored to assess changes in the diagnostic landscape in patients with chronic bloating\/distension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 1481 patients with chronic bloating\/distension were included. The rate of abnormal endoscopic examination of upper gastrointestinal tract (GI) symptoms was greater than that of lower GI symptoms (16.6% vs. 11.5%,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05). Logistic regression revealed that alarm signs were the only risk factor associated with abnormal upper GI findings (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.040; OR\u2009=\u20091.753; 95% CI: 1.026\u20132.995), and a disease duration greater than 6 months was a protective factor for positive lower GI endoscopy findings (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.036; OR\u2009=\u20090.590; 95% CI: 0.360\u20130.967). Comparative analysis revealed diverging diagnostic trends under the Rome IV criteria. Specifically, PDS diagnoses decreased by 6.1% and IBS by 7.7%, whereas FC, U-FDB and FAB\/D increased by 1.3%, 2.7% and 10.5%, respectively. EPS rates remained stable, with DGBI overlap diagnoses increasing by 1.2%.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The positive endoscopic finding of upper GI bloating\/distension was greater than that of lower GI, and the risk factors associated with positive findings were alarm symptoms but had limited sensitivity\/specificity. The transition from the Rome III to Rome IV criteria changed the diagnostic landscape for patients with chronic bloating.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12876-026-04634-7","type":"journal-article","created":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T13:55:02Z","timestamp":1769262902000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Endoscopic findings in patients with chronic bloating\/abdominal distension and the effect of the transition from the Rome III to Rome IV criteria: a multicenter cross-sectional study"],"prefix":"10.1186","volume":"26","author":[{"given":"Jiandi","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyue","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Bai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohua","family":"Hou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,24]]},"reference":[{"key":"4634_CR1","doi-asserted-by":"publisher","first-page":"1166","DOI":"10.1023\/A:1005554103531","volume":"45","author":"RS Sandler","year":"2000","unstructured":"Sandler RS, Stewart WF, Liberman JN, Ricci JA, Zorich NL. Abdominal pain, bloating, and diarrhea in the united states: prevalence and impact. Dig Dis Sci. 2000;45:1166\u201371.","journal-title":"Dig Dis Sci"},{"key":"4634_CR2","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1136\/gut.42.5.690","volume":"42","author":"NJ Talley","year":"1998","unstructured":"Talley NJ, Boyce P, Jones M. Identification of distinct upper and lower Gastrointestinal symptom groupings in an urban population. Gut. 1998;42:690\u20135.","journal-title":"Gut"},{"key":"4634_CR3","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1016\/S1542-3565(05)00153-9","volume":"3","author":"M Camilleri","year":"2005","unstructured":"Camilleri M, Dubois D, Coulie B, et al. Prevalence and socioeconomic impact of upper Gastrointestinal disorders in the united states: results of the US upper Gastrointestinal study. Clin Gastroenterol Hepatol. 2005;3:543\u201352.","journal-title":"Clin Gastroenterol Hepatol"},{"key":"4634_CR4","doi-asserted-by":"publisher","first-page":"2370","DOI":"10.1016\/j.cgh.2022.10.031","volume":"21","author":"JE Oh","year":"2023","unstructured":"Oh JE, Chey WD, Spiegel B. Abdominal bloating in the united states: results of a survey of 88,795 Americans examining prevalence and healthcare seeking. Clin Gastroenterol Hepatol. 2023;21:2370\u20137.","journal-title":"Clin Gastroenterol Hepatol"},{"key":"4634_CR5","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.1007\/s12325-019-00924-7","volume":"36","author":"A Mari","year":"2019","unstructured":"Mari A, Abu Backer F, Mahamid M, et al. Bloating and abdominal distension: clinical approach and management. Adv Ther. 2019;36:1075\u201384.","journal-title":"Adv Ther"},{"key":"4634_CR6","doi-asserted-by":"publisher","first-page":"14407","DOI":"10.3748\/wjg.v20.i39.14407","volume":"20","author":"P Iovino","year":"2014","unstructured":"Iovino P, Bucci C, Tremolaterra F, Santonicola A, Chiarioni G. Bloating and functional gastro-intestinal disorders: where are we and where are we going? World J Gastroenterol. 2014;20:14407\u201319.","journal-title":"World J Gastroenterol"},{"key":"4634_CR7","first-page":"S26","volume":"3","author":"P Daneshpajouhnejad","year":"2012","unstructured":"Daneshpajouhnejad P, Keshteli AH, Sadeghpour S, Ardestani SK, Adibi P. Bloating in iran: SEPAHAN systematic review 4. Int J Prev Med. 2012;3:S26\u201333.","journal-title":"Int J Prev Med"},{"key":"4634_CR8","doi-asserted-by":"publisher","first-page":"1867","DOI":"10.1046\/j.1365-2036.2002.01369.x","volume":"16","author":"S Zar","year":"2002","unstructured":"Zar S, Benson MJ, Kumar D. Review article: bloating in functional bowel disorders. Aliment Pharmacol Ther. 2002;16:1867\u201376.","journal-title":"Aliment Pharmacol Ther"},{"key":"4634_CR9","doi-asserted-by":"publisher","first-page":"1221","DOI":"10.1038\/ajg.2017.129","volume":"112","author":"JR Malagelada","year":"2017","unstructured":"Malagelada JR, Accarino A, Azpiroz F. Bloating and abdominal distension: old misconceptions and current knowledge. Am J Gastroenterol. 2017;112:1221\u201331. Epub 2017\/05\/17.","journal-title":"Am J Gastroenterol"},{"key":"4634_CR10","doi-asserted-by":"crossref","unstructured":"Ballou S, Singh P, Nee J et al. Prevalence and associated factors of bloating: results from the Rome foundation global epidemiology study. Gastroenterology. 2023;165:647\u201355.","DOI":"10.1053\/j.gastro.2023.05.049"},{"key":"4634_CR11","doi-asserted-by":"publisher","first-page":"1060","DOI":"10.1053\/j.gastro.2005.06.062","volume":"129","author":"F Azpiroz","year":"2005","unstructured":"Azpiroz F, Malagelada J-R. Abdom Bloating Gastroenterol. 2005;129:1060\u201378.","journal-title":"Abdom Bloating Gastroenterol"},{"key":"4634_CR12","doi-asserted-by":"publisher","first-page":"1221","DOI":"10.1038\/ajg.2017.129","volume":"112","author":"JR Malagelada","year":"2017","unstructured":"Malagelada JR, Accarino A, Azpiroz F. Bloating and abdominal distension: old misconceptions and current knowledge. Am J Gastroenterol. 2017;112:1221\u201331.","journal-title":"Am J Gastroenterol"},{"key":"4634_CR13","doi-asserted-by":"crossref","unstructured":"Palsson OS, Whitehead W, T\u00f6rnblom H, Sperber AD, Simren M. Prevalence of Rome IV functional bowel disorders among adults in the united States, Canada, and the united Kingdom. Gastroenterology. 2020;158:1262\u201373.","DOI":"10.1053\/j.gastro.2019.12.021"},{"key":"4634_CR14","doi-asserted-by":"crossref","unstructured":"Drossman DA, Hasler WL. Rome IV\u2014Functional GI Disorders: Disorders of Gut-Brain Interaction. Gastroenterology. 2016;150:1257\u20131261.","DOI":"10.1053\/j.gastro.2016.03.035"},{"key":"4634_CR15","doi-asserted-by":"publisher","first-page":"671","DOI":"10.7326\/0003-4819-111-8-671","volume":"111","author":"NJ Talley","year":"1989","unstructured":"Talley NJ, Phillips SF, Melton J, Wiltgen C, Zinsmeister AR. A patient questionnaire to identify bowel disease. Ann Intern Med. 1989;111:671\u20134.","journal-title":"Ann Intern Med"},{"key":"4634_CR16","doi-asserted-by":"crossref","unstructured":"Drossman DA, Chang L, Bellamy N et al. Severity in irritable bowel syndrome: a Rome foundation working team report. Am J Gastroenterol. 2011;106:1749\u201359 .","DOI":"10.1038\/ajg.2011.201"},{"key":"4634_CR17","doi-asserted-by":"publisher","first-page":"1481","DOI":"10.1053\/j.gastro.2016.02.014","volume":"150","author":"OS Palsson","year":"2016","unstructured":"Palsson OS, Whitehead WE, van Tilburg MAL, et al. Development and validation of the Rome IV diagnostic questionnaire for adults. Gastroenterology. 2016;150:1481\u201391.","journal-title":"Gastroenterology"},{"key":"4634_CR18","doi-asserted-by":"publisher","first-page":"1569","DOI":"10.1007\/BF01303162","volume":"38","author":"DA Drossman","year":"1993","unstructured":"Drossman DA, Li Z, Andruzzi E, et al. U.S. Householder survey of functional Gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci. 1993;38:1569\u201380.","journal-title":"Dig Dis Sci"},{"key":"4634_CR19","doi-asserted-by":"publisher","first-page":"1527","DOI":"10.1111\/jgh.13308","volume":"31","author":"RM Zagari","year":"2016","unstructured":"Zagari RM, Eusebi LH, Rabitti S, et al. Prevalence of upper Gastrointestinal endoscopic findings in the community: A systematic review of studies in unselected samples of subjects. J Gastroenterol Hepatol. 2016;31:1527\u201338.","journal-title":"J Gastroenterol Hepatol"},{"key":"4634_CR20","doi-asserted-by":"publisher","first-page":"759","DOI":"10.1111\/1751-2980.12693","volume":"19","author":"T Bai","year":"2018","unstructured":"Bai T, Wang WF, Zhang L, et al. Positive endoscopic and ultrasonographic findings in patients with symptom-diagnosed functional Gastrointestinal disorder: data from a Chinese cross-sectional study. J Dig Dis. 2018;19:759\u201365.","journal-title":"J Dig Dis"},{"key":"4634_CR21","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1136\/gut.2009.192401","volume":"59","author":"Y Bai","year":"2010","unstructured":"Bai Y, Li Z-S, Zou D-W, et al. Alarm features and age for predicting upper Gastrointestinal malignancy in Chinese patients with dyspepsia with high background prevalence of Helicobacter pylori infection and upper Gastrointestinal malignancy: an endoscopic database review of 102,665 patients from 1996 to 2006. Gut. 2010;59:722\u20138.","journal-title":"Gut"},{"key":"4634_CR22","doi-asserted-by":"crossref","unstructured":"Kamran M, Fawwad A, Haider SI, Hussain T, Ahmed J. Upper Gastrointestinal endoscopy; A study from a rural population of Sindh, Pakistan. Pak J Med Sci. 2021;37:9\u201314.","DOI":"10.12669\/pjms.37.1.3297"},{"key":"4634_CR23","first-page":"52","volume":"40","author":"J Wu","year":"2019","unstructured":"Wu J, Lu AD, Zhang LP, Zuo YX, Jia YP. [Study of clinical outcome and prognosis in pediatric core binding factor-acute myeloid leukemia]. Zhonghua Xue Ye Xue Za Zhi. 2019;40:52\u20137.","journal-title":"Zhonghua Xue Ye Xue Za Zhi"},{"key":"4634_CR24","doi-asserted-by":"publisher","first-page":"e39173","DOI":"10.1371\/journal.pone.0039173","volume":"7","author":"H Khademi","year":"2012","unstructured":"Khademi H, Radmard A-R, Malekzadeh F, et al. Diagnostic accuracy of age and alarm symptoms for upper GI malignancy in patients with dyspepsia in a GI clinic: a 7-year cross-sectional study. PLoS ONE. 2012;7:e39173.","journal-title":"PLoS ONE"},{"key":"4634_CR25","doi-asserted-by":"publisher","first-page":"64","DOI":"10.5056\/jnm22197","volume":"30","author":"F Chen","year":"2024","unstructured":"Chen F, Tan N, Chen S, Zhuang Q, Zhang M, Xiao Y. The disease spectrum and natural history of patients with abdominal bloating or distension: A longitudinal study. J Neurogastroenterol Motil. 2024;30:64\u201372.","journal-title":"J Neurogastroenterol Motil"},{"issue":"Suppl 2","key":"4634_CR26","first-page":"II1","volume":"45","author":"DA Drossman","year":"1999","unstructured":"Drossman DA. The functional Gastrointestinal disorders and the Rome II process. Gut. 1999;45(Suppl 2):II1\u20135.","journal-title":"Gut"},{"issue":"Suppl 2","key":"4634_CR27","doi-asserted-by":"publisher","first-page":"II43","DOI":"10.1136\/gut.45.2008.ii43","volume":"45","author":"WG Thompson","year":"1999","unstructured":"Thompson WG, Longstreth GF, Drossman DA, Heaton KW, Irvine EJ, M\u00fcller-Lissner SA. Functional bowel disorders and functional abdominal pain. Gut. 1999;45(Suppl 2):II43\u20137.","journal-title":"Gut"},{"key":"4634_CR28","doi-asserted-by":"crossref","unstructured":"Asghar Z, Thoufeeq M, Kurien M et al. Diagnostic yield of colonoscopy in patients with symptoms compatible with Rome IV functional bowel disorders. Clin Gastroenterol Hepatol. 2022;20:334\u201341.","DOI":"10.1016\/j.cgh.2020.08.062"},{"key":"4634_CR29","doi-asserted-by":"publisher","first-page":"509","DOI":"10.5056\/jnm15167","volume":"22","author":"MS Ryu","year":"2016","unstructured":"Ryu MS, Jung H-K, Ryu J-I, Kim J-S, Kong KA. Clinical dimensions of bloating in functional Gastrointestinal disorders. J Neurogastroenterol Motil. 2016;22:509\u201316.","journal-title":"J Neurogastroenterol Motil"},{"key":"4634_CR30","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/s13030-016-0070-8","volume":"10","author":"M Kanazawa","year":"2016","unstructured":"Kanazawa M, Miwa H, Nakagawa A, Kosako M, Akiho H, Fukudo S. Abdominal bloating is the most bothersome symptom in irritable bowel syndrome with constipation (IBS-C): a large population-based internet survey in Japan. Biopsychosoc Med. 2016;10:19.","journal-title":"Biopsychosoc Med"},{"key":"4634_CR31","doi-asserted-by":"crossref","unstructured":"Lacy BE, Cangemi D, Vazquez-Roque M. Management of chronic abdominal distension and bloating. Clin Gastroenterol Hepatol. 2021;19:219\u201331.","DOI":"10.1016\/j.cgh.2020.03.056"},{"key":"4634_CR32","doi-asserted-by":"publisher","first-page":"1708","DOI":"10.1136\/gut.52.12.1708","volume":"52","author":"H Harder","year":"2003","unstructured":"Harder H, Serra J, Azpiroz F, Passos MC, Aguad\u00e9 S, Malagelada JR. Intestinal gas distribution determines abdominal symptoms. Gut. 2003;52:1708\u201313.","journal-title":"Gut"},{"key":"4634_CR33","doi-asserted-by":"publisher","first-page":"1346","DOI":"10.1016\/S0016-5085(98)70012-5","volume":"115","author":"J Tack","year":"1998","unstructured":"Tack J, Piessevaux H, Coulie B, Caenepeel P, Janssens J. Role of impaired gastric accommodation to a meal in functional dyspepsia. Gastroenterology. 1998;115:1346\u201352.","journal-title":"Gastroenterology"},{"key":"4634_CR34","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1016\/S1590-8658(04)00082-9","volume":"36","author":"G Sarnelli","year":"2004","unstructured":"Sarnelli G, Vandenberghe J, Tack J. Visceral hypersensitivity in functional disorders of the upper Gastrointestinal tract. Dig Liver Dis. 2004;36:371\u20136.","journal-title":"Dig Liver Dis"},{"key":"4634_CR35","doi-asserted-by":"crossref","unstructured":"Maratka Z. Abdominal bloating and distension in functional Gastrointestinal disorders - epidemiology and possible mechanisms. Aliment Pharmacol Ther. 2008;27:713\u20134.","DOI":"10.1111\/j.1365-2036.2008.03616.x"},{"key":"4634_CR36","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1097\/01.JAA.0000000000000035","volume":"37","author":"KA Carter","year":"2024","unstructured":"Carter KA. Irritable bowel syndrome: clinical practice update. JAAPA. 2024;37:13\u20138.","journal-title":"JAAPA"},{"key":"4634_CR37","doi-asserted-by":"publisher","first-page":"1241","DOI":"10.1111\/j.1572-0241.2007.01755.x","volume":"103","author":"AK Tuteja","year":"2008","unstructured":"Tuteja AK, Talley NJ, Joos SK, Tolman KG, Hickam DH. Abdominal bloating in employed adults: prevalence, risk factors, and association with other bowel disorders. Am J Gastroenterol. 2008;103:1241\u20138.","journal-title":"Am J Gastroenterol"},{"key":"4634_CR38","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1016\/S2468-1253(20)30217-X","volume":"5","author":"P Oka","year":"2020","unstructured":"Oka P, Parr H, Barberio B, Black CJ, Savarino EV, Ford AC. Global prevalence of irritable bowel syndrome according to Rome III or IV criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020;5:908\u201317.","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"4634_CR39","doi-asserted-by":"publisher","unstructured":"Tornkvist N, Palsson OS, Hreinsson J et al. Global prevalence, characterization and impact of functional bowel disorders. Am J Gastroenterol. 2025. https:\/\/doi.org\/10.14309\/ajg.0000000000003782.","DOI":"10.14309\/ajg.0000000000003782"},{"key":"4634_CR40","doi-asserted-by":"crossref","unstructured":"Simadibrata DM, Koo TH, Utari AP et al. Rome III versus Rome IV criteria for diagnosing irritable bowel syndrome in a Southeast Asian population: insights from the Rome foundation global epidemiology study household survey. J Gastroenterol Hepatol. 2026;41:168\u201379.","DOI":"10.1111\/jgh.70174"}],"container-title":["BMC Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12876-026-04634-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-026-04634-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12876-026-04634-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T17:06:23Z","timestamp":1781629583000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12876-026-04634-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,24]]},"references-count":40,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4634"],"URL":"https:\/\/doi.org\/10.1186\/s12876-026-04634-7","relation":{},"ISSN":["1471-230X"],"issn-type":[{"value":"1471-230X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,24]]},"assertion":[{"value":"19 April 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the ethics committee of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (2021\u20130876), and in accordance with the Helsinki Declaration of 1975 as revised in 2013. The study was conducted by means of an outpatient questionnaire, and the privacy of the subjects was protected. Thus, the hospital ethics committee of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology waived the need for written informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"134"}}