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    Rome IV Diagnostic Criteria for Functional Diarrhea

    Official Rome IV criteria for the diagnosis of functional diarrhea.


    Use in patients with symptoms of chronic diarrhea for at least the last 6 months where there is not a clear systemic cause for diarrhea (e.g. secondary diarrhea).

    Patients with any of the following features must be evaluated clinically for other diagnoses even though functional diarrhea may be present:

    • Signs or symptoms of gastrointestinal bleeding.

    • Unexplained iron deficiency anemia.

    • Unintentional weight loss or evidence of malnutrition.

    • Palpable abdominal mass or lymphadenopathy on exam.

    • Family history of colon cancer and have not had age-appropriate colon cancer screening. Family history of inflammatory bowel disease or celiac disease.

    • Onset of symptoms age ≥50 years and have not had age-appropriate colon cancer screening.

    • Sudden or acute onset of new change in bowel habit.

    • Diarrhea awakening the patient at night.

    • Recent antibiotic use.

    • High volume diarrhea.

    • Fever.

    When to Use
    Why Use

    Patients presenting with chronic diarrhea for at least the past 6 months with no clear systemic cause of chronic diarrhea. The diagnosis of functional diarrhea should be made based on clinical history, physical examination, and diagnostic tests.

    • Diarrhea should be defined by stool form and not frequency.

    • Use the Bristol Stool Form Scale to determine stool form. It is important that patients look at both the pictures and the text. Bristol Stool Form type 6 or 7 are considered diarrhea. Be sure to evaluate stool form when the patient is off medications that affect bowel habit. 

    • If abdominal pain is present in addition to diarrhea symptoms, a diagnosis of the diarrhea-predominant irritable bowel syndrome (IBS-D) should be considered.

    • Biopsies of right and left colon to assess for microscopic colitis should be taken when a colonoscopy is performed. This should be done even if the colonic mucosa appears normal.

    • Used to diagnose functional diarrhea in the absence of secondary causes of diarrhea.

    • Making a diagnosis will help guide the need for further work-up and management.

    • Can be used to discuss signs and symptoms of functional diarrhea with patients.

    Must have the following:

    For 3 months prior with symptom onset ≥6 months ago

    Diagnostic Result:

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    Next Steps
    Creator Insights
    Dr. Douglas Drossman

    About the Creator

    Douglas Drossman, MD, is professor emeritus of medicine and psychiatry at the University of North Carolina School of Medicine. He is founder, President Emeritus and Chief of Operations of the Rome Foundation. He is also the founder of the Drossman Center for the Education and Practice of Biopsychosocial Care and Drossman Consulting, LLC. Dr. Drossman has written over 500 articles and book chapters, has published two books, a GI procedure manual and a textbook of functional GI disorders (Rome I-IV), and serves on six editorial and advisory boards.

    To view Dr. Douglas Drossman's publications, visit PubMed

    Dr. Lin Chang

    About the Creator

    Lin Chang, MD is responsible for the oversight and coordination of the Rome IV calculators on MDCalc. She is a Professor of Medicine at the Vatche and Tamar Manoukian Division of Digestive Diseases at UCLA and is a member of the Rome Foundation Board of Directors.

    To view Dr. Lin Chang's publications, visit PubMed

    The Rome Foundation

    About the Creator

    The Rome Foundation is an independent not for profit 501(c) 3 organization that provides support for activities designed to create scientific data and educational information to assist in the diagnosis and treatment of Disorders of Gut-Brain Interaction (DGBI), also known as functional gastrointestinal (GI) disorders. Their mission is to improve the lives of people with DGBI. Over the last 3 decades, the Rome organization has sought to legitimize and update our knowledge of the DGBIs. This has been accomplished by bringing together scientists and clinicians from around the world to classify and critically appraise the science of GI function and dysfunction. This knowledge permits clinical scientists to make recommendations for diagnosis and treatment that can be applied in research and clinical practice. Diagnosis is based on the use of symptom-based criteria which are used in clinical trials and daily practice. The list of Rome IV categories and the Chair and Co-Chair of each chapter committee are listed below.

    Committees Chair Co-Chair
    Esophageal Disorders Ronnie Fass, MD John Pandolfino, MD
    Gastroduodenal Disorders Nicholas J. Talley, MD, PhD, FRACP Vincenzo Stanghellini, MD
    Bowel Disorders Fermin Mearin, MD Brian Lacy, MD, PhD
    Gallbladder and Sphincter of Oddi Disorders Grace Elta, MD Peter Cotton, MD
    Centrally Mediated Disorders of Gastrointestinal Pain Peter J. Whorwell, MD Laurie Keefer, PhD
    Anorectal Disorders Adil E. Bharucha, MD, MBBS Satish S. C. Rao, MD, PhD, FRCP
    Childhood Functional Gastrointestinal Disorders: Neonate/Toddler Sam Nurko, MD Marc A. Benninga, MD
    Childhood Functional Gastrointestinal Disorders: Child/Adolescent Carlo Di Lorenzo, MD Jeffrey S. Hyams, MD

    Rome IV Diagnostic Criteria Chapters, Chairs and Co-Chairs

    Rome IV Editorial Board: Douglas A. Drossman, MD, Senior Editor, Lin Chang, MD, William D. Chey, MD, John Kellow, MD, Jan Tack, MD, PhD, and William E. Whitehead, PhD.

    To view The Rome Foundation's publications, visit PubMed

    Content Contributors
    • Colleen Parker, MD
    Reviewed By
    • Dr. Lin Chang
    About the Creator
    Dr. Douglas Drossman
    Dr. Lin Chang
    The Rome Foundation
    Content Contributors
    • Colleen Parker, MD
    Reviewed By
    • Dr. Lin Chang