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The Rome criteria are developed through a collaboration of researchers, healthcare providers, and other health professionals from around the world. The Rome IV criteria reflect the fourth revision of the FGD diagnostic criteria and were published in 2016.
Types of Functional Gastrointestinal Disorders
Each FGD disorder has its own set of criteria. The following are the major categories of FGDs according to the Rome IV criteria:
The Rome IV Criteria for IBS
The criteria for a diagnosis ofirritable bowel syndrome(IBS) require that a person be experiencing recurrent abdominal pain on average at least one day a week in the last three months, with an onset of symptoms at least six months prior. Pain must be associated with two or more of the following:
Because IBS can have variable symptoms, the condition is classified into four subtypes:
Although the Rome IV criteria are followed strictly in clinical research trials, in the real world, healthcare providers often give a diagnosis of IBS to anyone who is experiencing bowel symptoms without any visible inflammation or other signs of disease showing up through standard digestive testing.
Other Functional Bowel Disorders
The following are other types of functional bowel disorders. A person would be diagnosed with one of these other disorders when they don’t fit the diagnostic criteria for IBS (or any other disease or FGD). Often these other disorders are differentiated from IBS due to the lack of pain as a symptom.
Functional abdominal bloating/distension:Chronic feelings of bloating and/or visible distension occur. The symptom must have occurred at least one day a week over the last three months with symptom onset at least six months prior to diagnosis. However, abdominal bloating and/or distension must be the main symptom and other functional GI disorders should be excluded.
Functional diarrhea:Loose or watery stools (without predominant pain or bloating) are experienced in at least 25% of bowel movements for at least three months with symptom onset at least six months prior. IBS with predominant diarrhea should be excluded.
Functional constipation:Symptoms must include at least two of the following and have been experienced for at least three months with symptom onset at least six months prior:
Unspecified functional bowel disorder:Bowel symptoms are not attributable to an organic etiology that does not meet the criteria for IBS or functional constipation, diarrhea, or abdominal bloating/distension disorders. Symptoms must have occurred for the last three months with onset at least six months prior to diagnosis.
Opioid-induced constipation:New or worsening symptoms of constipation occur when initiating, changing, or increasing opioid therapy, that must include two or more of the following:
Opioid-induced constipation is also defined as loose stools rarely being present without the use of laxatives.
Rome IV in the Real World
As designed, the Rome IV criteria provide a strong basis for identifying patients for research studies. However, healthcare providers in their clinical practice don’t always focus on such exacting criteria when offering functional diagnoses to their patients. Thus, there is no need to be overly concerned if you receive a diagnosis that doesn’t completely conform to the criteria. But if you still have any questions about your diagnosis, ask your healthcare provider for clarification.
Colonoscopy and Irritable Bowel Syndrome (IBS): What to Know
3 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Drossman DA, Hasler WL.Rome IV—Functional GI disorders: disorders of gut-brain interaction.Gastroenterology. 2016;150(6):1257-1261. doi:10.1053/j.gastro.2016.03.035Schmulson MJ, Drossman DA.What Is New in Rome IV.J Neurogastroenterol Motil. 2017;23(2):151-163. doi:10.5056/jnm16214Mearin F, Lacy BE, Chang L, et al.Bowel Disorders.Gastroenterology. Published online February 18, 2016. doi:10.1053/j.gastro.2016.02.031
3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Drossman DA, Hasler WL.Rome IV—Functional GI disorders: disorders of gut-brain interaction.Gastroenterology. 2016;150(6):1257-1261. doi:10.1053/j.gastro.2016.03.035Schmulson MJ, Drossman DA.What Is New in Rome IV.J Neurogastroenterol Motil. 2017;23(2):151-163. doi:10.5056/jnm16214Mearin F, Lacy BE, Chang L, et al.Bowel Disorders.Gastroenterology. Published online February 18, 2016. doi:10.1053/j.gastro.2016.02.031
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Drossman DA, Hasler WL.Rome IV—Functional GI disorders: disorders of gut-brain interaction.Gastroenterology. 2016;150(6):1257-1261. doi:10.1053/j.gastro.2016.03.035Schmulson MJ, Drossman DA.What Is New in Rome IV.J Neurogastroenterol Motil. 2017;23(2):151-163. doi:10.5056/jnm16214Mearin F, Lacy BE, Chang L, et al.Bowel Disorders.Gastroenterology. Published online February 18, 2016. doi:10.1053/j.gastro.2016.02.031
Drossman DA, Hasler WL.Rome IV—Functional GI disorders: disorders of gut-brain interaction.Gastroenterology. 2016;150(6):1257-1261. doi:10.1053/j.gastro.2016.03.035
Schmulson MJ, Drossman DA.What Is New in Rome IV.J Neurogastroenterol Motil. 2017;23(2):151-163. doi:10.5056/jnm16214
Mearin F, Lacy BE, Chang L, et al.Bowel Disorders.Gastroenterology. Published online February 18, 2016. doi:10.1053/j.gastro.2016.02.031
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