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    Rome IV Diagnostic Criteria for Functional Abdominal Bloating/Distension

    Official Rome IV criteria for the diagnosis of functional abdominal bloating or distension.


    Use in patients with symptoms of abdominal bloating and/or distension for at least the last 6 months where there is not a clear systemic cause for their symptoms. 

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

    • Signs or symptoms of gastrointestinal bleeding.

    • Unexplained iron deficiency anemia.

    • Unintentional weight loss.

    • Palpable abdominal mass or lymphadenopathy on exam.

    • Family history of colon cancer and have not had age-appropriate colon cancer screening.

    • 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.

    • Symptoms suggestive of bowel obstruction.

    When to Use
    Why Use

    Use in patients with symptoms of abdominal bloating and/or distension for at least the last 6 months where there is not a clear systemic cause for their symptoms. In addition they do not fulfill criteria for another disorder of gut-brain interaction (also known as functional GI disorder) such as irritable bowel syndrome (IBS), functional constipation, functional diarrhea or functional dyspepsia. The diagnosis of functional abdominal bloating/distension should be made by clinical history, physical examination, and minimal laboratory tests.

    • Bloating is defined as the subjective sensation of abdominal fullness, abdominal pressure or the sensation of trapped gas.

    • Distension is defined as the objective or measurable increase in abdominal girth. Consider the diagnosis of abdominophrenic dyssynergia in patients with visible abdominal distension after meals.

    • Patients may have abdominal bloating, distension or both to meet the diagnosis of functional abdominal bloating and distension.

    • A typical description for abdominal bloating and distension is that it worsens as the day progresses and after ingestion of a meal. Symptoms often are alleviated overnight.

    • Bloating and distension are commonly reported symptoms in other disorders of gut-brain interaction and these should be ruled out. Examples include IBS, functional constipation, functional diarrhea, and functional dyspepsia.

    • Altered bowel habits and abdominal pain may be present to a minor degree but are not used to diagnose functional abdominal bloating/distension. 

    • For women, the abdominal bloating and distension should not exclusively occur during their menstrual period.

    • In women, with new onset abdominal bloating/distension, consideration of a pelvic exam and/or ultrasound should be considered.

    • Used to diagnose functional abdominal bloating/distension in the absence of secondary causes of abdominal bloating/distension and another disorder of gut-brain interaction.

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

    Must have the following:

    For 3 months prior with symptom onset ≥6 months ago

    Diagnostic Result:

    Please fill out required fields.

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