Rome Criteria
Original Editor - Khloud Shreif
Top Contributors - Khloud Shreif
Objective
The Rome criteria were initially developed in 1987 by Torsoli to address various overlapping gastrointestinal issues in infants, which were functional in nature. In 1991, the Rome I criteria for diagnosing functional gastrointestinal disorders (FGIDs) in adults were introduced. These criteria were further refined and expanded in the Rome II criteria, published in 1999 and 2000, which included new insights on gut motility, sensitivity, brain-gut interactions, and psychosocial aspects of FGIDs. In 2006, the Rome III criteria were established, to provide more comprehensive guidelines for diagnosing children with abdominal pain-related FGIDs[1]. The latest update, the Rome IV criteria, was released in May 2016, offering a unified diagnostic framework for patients of all ages, from infants to adults[2].
Intended Population
The Rome IV criteria are available to use different age groups; infants, children, and adult with gastrointestinal disorders including:
- Bowel disorders (irritable bowel syndrome, functional constipation, functional diarrhea).
- Anorectal disorders (fecal incontinence, functional anorectal pain and Functional defecation disorders including dyssynergic defecation).
- Childhood Functional GI Disorders
- Esophageal Disorders
- Gastroduodenal Disorders[3]
Method of Use For Bowel and Anorectal disorders
| Irritable Bowel Syndrome IBS | Characterized by abdominal pain occurring at least one day per week, this pain is linked with at least two of the following symptoms: |
| Functional Constipation | They didn't met all criteria of IBS and there was no abdominal pain, The symptoms must include at least two of the following:
|
| Functional Diarrhea | Loose or watery stools, without predominant abdominal pain or bothersome bloating, occur in more than 25% of stool. |
| Dyssynergic Defecation or inadequate defecatory
propulsion |
Patients must meet the diagnostic criteria for either IBS-C (Irritable Bowel Syndrome with Constipation) or functional constipation, but also exhibit signs of impaired rectal evacuation according to two of the following three tests:
|
| Fecal Incontinence | Recurrent uncontrolled passage of fecal material in an individual with a developmental age of at least 4 years |
| Functional anorectal pain | |
| The above criteria must have been present for the last 3 months and began at least 6 months prior to diagnosis[4]. | |
Evidence
Sensitivity
The Rome IV criteria show different levels of sensitivity to detect different functional gastrointestinal disorders as following:
- For irritable bowel syndrome (IBS), the criteria have a high sensitivity of about 78.4%, showing they are effective in identifying most cases when patients report abdominal pain weekly.
- The sensitivity for Functional Dyspepsia (FD) is lower at 54.7%.
- For functional constipation (FC), sensitivity varies significantly from 33.9% under strict conditions that exclude overlapping issues like opioid-induced constipation and IBS, to 70.5% when such conditions are included. that depends on how criteria are applied to patients.[6]
Validity
It has a strong content validity supported by extensive expert research and consensus[6].
Reliability
According to test retest reliability, Rome IV criteria prove to have moderate reliability[6].
Responsiveness
However the criteria contain symptoms for different FGIDs and information about symptoms' duration, frequency to track patient symptoms, there is lack of studies to confirm its responsiveness.
Resources
References
- ↑ Rasquin A. History and Definition of the Rome Criteria. InPediatric Neurogastroenterology: Gastrointestinal Motility and Functional Disorders in Children 2012 Nov 7 (pp. 325-329). Totowa, NJ: Humana Press.
- ↑ Schmulson MJ, Drossman DA. What is new in Rome IV. Journal of neurogastroenterology and motility. 2017 Apr;23(2):151.
- ↑ Schmulson MJ, Drossman DA. What is new in Rome IV. Journal of neurogastroenterology and motility. 2017 Apr;23(2):151.
- ↑ 4.0 4.1 4.2 4.3 Aziz I, Whitehead WE, Palsson OS, Törnblom H, Simrén M. An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation. Expert review of gastroenterology & hepatology. 2020 Jan 2;14(1):39-46.
- ↑ Vork L, Weerts ZZ, Mujagic Z, Kruimel JW, Hesselink MA, Muris JW, Keszthelyi D, Jonkers DM, Masclee AA. Rome III vs Rome IV criteria for irritable bowel syndrome: a comparison of clinical characteristics in a large cohort study. Neurogastroenterology & Motility. 2018 Feb;30(2):e13189.
- ↑ 6.0 6.1 6.2 Palsson OS, Whitehead WE, Van Tilburg MA, Chang L, Chey W, Crowell MD, Keefer L, Lembo AJ, Parkman HP, Rao SS, Sperber A. Development and validation of the Rome IV diagnostic questionnaire for adults. Gastroenterology. 2016 May 1;150(6):1481-91.