The Rome IV criteria are a set of diagnostic guidelines used to classify functional gastrointestinal disorders (FGIDs), now referred to as disorders of gut-brain interaction, based on symptom patterns. They are a symptom-based system used in both clinical practice and research to help diagnose conditions like irritable bowel syndrome (IBS) or functional dyspepsia when no other medical explanation is found through standard tests. Examples include specific criteria for IBS, such as abdominal pain at least once a week, or for functional dyspepsia, including chronic or recurrent epigastric pain, fullness, or burning.
Key aspects of the Rome IV criteria
Symptom-based:
Diagnosis is based on patterns of symptoms, not on findings from tests or scans.
Disorders of gut-brain interaction:
The criteria aim to classify disorders where the brain and gut interact abnormally, rather than calling them "functional" (which may be stigmatizing).
Diagnostic algorithms:
The criteria are supported by updated diagnostic algorithms, questionnaires, and educational materials.
Evidence-based thresholds:
Some criteria were updated based on epidemiological data to be more evidence-based and practical, such as the increased frequency for abdominal pain in IBS to at least once a week, notes the Rome Foundation .
Specific criteria:
For IBS (in adults): Includes recurrent abdominal pain at least once a week, on average, over the last 3 months, associated with either defecation, or a change in stool frequency, or a change in stool form.
For Functional Dyspepsia (in adults): Includes one or more of the following for at least 3 months with symptom onset at least 6 months prior to diagnosis: bothersome postprandial fullness, early satiation, or epigastric pain or burning.
For functional constipation: Includes two or more of the following over the past six months: fewer than 3 bowel movements per week; straining for at least 25% of defecations; lumpy or hard stools for at least 25% of defecations; and feeling of incomplete evacuation for at least 25% of defecations.
Exclusion of other conditions:
After a proper evaluation, symptoms should not be fully explained by another medical condition.