Pictograms are more effective than verbal descriptors in Spanish for bloating and distension

BACKGROUND: There is no translation for bloating in Spanish, and distension is very technical. AIMS: To evaluate pictograms for assessing bloating/distension in patients with general gastroenterology (Study 1, n = 88) and in those with irritable bowel syndrome [IBS] (Study 2: n = 144), and to correlate them with verbal descriptors (VDs) and physician's diagnosis (PDx). METHODS: Patients answered the Rome III Questionnaire with VDs and pictograms, and were consulted by two gastroenterology fellows (PDx). Correlations were conducted with Cohen's kappa, and ROC curves were used to contrast pictograms and VDs with PDx. RESULTS: "Inflammation" was the most frequent VDs, while distension was commonly interpreted as a sensation ("inflammation") and/or increased abdominal girth. In patients not reporting bloating/distension with VDs, pictograms detected these symptoms in (Study 1 and Study 2) 82.2 and 89.6% of patients. In addition, pictograms showed a positive agreement with PDx, kappa: 0.63 (p < 0.0001) and 0.8 (p < 0.0001); and a negative agreement with VD, kappa: -0.45 (p = 0.05) and -0.1 (p = 0.2), respectively, in studies 1 and 2. Pictograms were more sensitive and specific than VDs (Study 1: ROC = 0.90 (95% CI: 0.80-0.96), p < 0.0001 versus 0.74 (0.62-0.88), p < 0.0001; Study 2: 0.99 (0.98-1.00), p = 0.004 versus 0.32 (0.10-0.54), p = 0.294). CONCLUSIONS: Pictograms are more effective than Spanish VDs for bloating/distension in patients consulting for gastroenterology problems and those with IBS, supporting their usefulness in the clinic and research studies.