SAN DIEGO — The international, nonprofit Rome Foundation revealed the fourth edition of its diagnostic criteria for functional GI disorders at Digestive Disease Week, which provides a new definition for functional GI disorders and includes new adult and pediatric diagnoses and diagnostic changes for irritable bowel syndrome.
“The diagnostic criteria for functional GI and some motility disorders have gone through four editions, so the one that's just been released — Rome IV — is being published about 10 years after Rome III. It tries to incorporate the research that’s been done since that time,” William E. Whitehead, PhD, professor of medicine in the division of gastroenterology and hepatology and director of the University of North Carolina Center for Functional GI and Motility Disorders, who has served on the Rome Foundation Board since its inception, said in a press release.
“Our job was, in part, to develop a diagnostic questionnaire based on criteria that committees of experts developed for making these diagnoses. Developing these materials was a multi-year process to be sure it was understandable and translatable to other languages and that it was valid in the sense that it agrees with the diagnoses of expert clinicians.”
William E. Whitehead
A key change in Rome IV is the removal of unnecessary use of the term “functional” due to its history of meaning “not organic, psychiatric or illegitimate,” Douglas A. Drossman, MD, emeritus co-director of the University of North Carolina Center for Functional GI and Motility Disorders, and president of the Rome Foundation, said during his presentation.
Moreover, the new edition essentially redefines the concept of functional GI disorders. “There is a very strong consensus that we should look at these as a group of disorders classified by GI symptoms related to any combination of motility disturbance, visceral hypersensitivity, altered mucosal and immune function, altered gut microbiota and altered CNS processing,” Drossman said. Similarly, Rome IV introduces “a better conceptualization” of functional bowel disorders as existing on a spectrum of both stool consistency and pain, along which patients can migrate across conditions, Drossman said.
New diagnoses added to this edition include reflux hypersensitivity syndrome, cannabinoid hyperemesis syndrome (CHS), opioid-induced constipation (OIC) and narcotic bowel syndrome (NBS). “Many purists would say [these] are not really functional because [they have] a cause, but we have to rethink ... this in the 21st century,” Drossman said. “What we’re really saying is that these are conditions that will mimic other so-called functional GI conditions, which ... may have specific etiologies, and [they are] also consistent with our [new] definition [for functional GI disorders].”
Rome IV also introduces new diagnostic criteria for IBS. “In the adult criteria, [IBS] used to be diagnosed based on the presence of abdominal pain or discomfort at least three times a month,” Whitehead said in the press release. “The new criteria require that there be pain — so discomfort doesn’t qualify — and it requires that it occur at least once a week on average. There are also some changes in the way that sub-types of IBS are diagnosed, which often dictate what treatment is appropriate — what drugs, especially.”
Specifically, IBS subtypes are now based on abnormal stool type occurring at least 25% of days, according to Drossman. “If you try to look at these patients over time, many of them have normal bowel movements, and then they may be classified as IBS-U, and that’s not a good target for treatment,” he said during his presentation.
Finally, a number of other important changes can be found in the new edition, including the elimination of sphincter of Oddi disorders type I and III, and the combination of functional nausea and functional vomiting into chronic nausea vomiting syndrome (CNVS).
In addition to other supplements to the fourth edition of the diagnostic criteria, the Rome Foundation has also launched the second editions of its Diagnostic Algorithms for Common GI symptoms and its Multidimensional Clinical Profile for Functional GI Disorders, Drossman said. – by Adam Leitenberger
Drossman D. Sp346: Overview of Rome IV: Changes in Criteria and New Educational Concepts. Presented at: Digestive Disease Week; May 21-24, 2016; San Diego.
Disclosures: Drossman is president of the Rome Foundation and reports consulting for and/or serving on advisory or review panels for AstraZeneca, Allergan, Takeda, Sucampo and Synergy. Whitehead is on the Rome Foundation Board and reports consulting for Biomerica USA, Ono Pharmaceuticals, Ferring Pharmaceuticals, and has received financial benefits and grant/research support from Takeda.