J Neurogastroenterol Motil  
Assessment of the Asian Neurogastroenterology and Motility Association Chronic Constipation Criteria: An Asian Multicenter Cross-sectional Study
Kok-Ann Gwee,1,* Paul Bergmans,2 JinYong Kim,3 Bogdana Coudsy,4 Angelia Sim,5 Minhu Chen,6 Lin Lin,7 Xiaohua Hou,8 Huahong Wang,9 Khean-Lee Goh,10 John A Pangilinan,11 Nayoung Kim,12 Stanislas Bruley des Varannes13
1Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore;
2Biometrics Department, Janssen Cilag Benelux, Tilburg, The Netherlands;
3Regional Medical Affairs, Janssen Asia-Pacific, Singapore;
4Janssen EMEA, Issy-les-Moulineaux, France;
5Global Clinical Operations, Janssen, Selangor, Malaysia
6Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China;
7Department of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University People’s Hospital of Jiangsu Province, China
8Department of Gastroenterology and Hepatology, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China;
9Gastrointestinal Department, Peking University First Hospital, Beijing, China;
10University of Malaya, Kuala Lumpur, Malaysia;
11Department of Internal Medicine Section of Gastroenterology, St Luke’s Medical Center, Institute of Digestive and Liver Diseases, Quezon, The Philippines;
12Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea; and
13Institut des Maladies de l’Appareil Digestif, University Hospital of Nantes, Nantes, France
Correspondence to: Kok-Ann Gwee, FRCP, PhD
Stomach Liver and Bowel Centre, Gleneagles Hospital, Annexe Block 05-37, 6A Napier Road, Singapore 258500, Singapore
Tel: +65-6474-6848, Fax: +65-6470-5616, E-mail: slbclinic@gmail.com
Received: June 13, 2016; Revised: September 5, 2016; Accepted: September 16, 2016; Published online: October 21, 2016.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

cc This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
There is a need for a simple and practical tool adapted for the diagnosis of chronic constipation (CC) in the Asian population. This study compared the Asian Neurogastroenterology and Motility Association (ANMA) CC tool and Rome III criteria for the diagnosis of CC in Asian subjects.
This multicenter, cross-sectional study included subjects presenting at outpatient gastrointestinal clinics across Asia. Subjects with CC alert symptoms completed a combination Diagnosis Questionnaire to obtain a diagnosis based on 4 different diagnostic methods: self-defined, investigator’s judgment, ANMA CC tool, and Rome III criteria. The primary endpoint was the level of agreement/disagreement between the ANMA CC diagnostic tool and Rome III criteria for the diagnosis of CC.
The primary analysis comprised 449 subjects, 414 of whom had a positive diagnosis according to the ANMA CC tool. Rome III positive/ANMA positive and Rome III negative/ANMA negative diagnoses were reported in 76.8% and 7.8% of subjects, respectively, resulting in an overall percentage agreement of 84.6% between the 2 diagnostic methods. The overall percentage disagreement between these 2 diagnostic methods was 15.4. A higher level of agreement was seen between the ANMA CC tool and self-defined (374 subjects [90.3%]) or investigator’s judgment criteria (388 subjects [93.7%]) compared with Rome III criteria.
This study demonstrates that the ANMA CC tool can be a useful tool for Asian patients with CC.
Keywords: Asia; Chronic; Constipation; Cross-sectional studies; Questionnaire

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