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:
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Signs or symptoms of gastrointestinal bleeding.
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Unexplained iron deficiency anemia.
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Unintentional weight loss.
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Palpable abdominal mass or lymphadenopathy on exam.
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Family history of colon cancer and have not had age-appropriate colon cancer screening.
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Onset of symptoms age ≥50 years and have not had age-appropriate colon cancer screening.
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Sudden or acute onset of new change in bowel habit.
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Symptoms suggestive of bowel obstruction.
If diagnosis not met (negative):
Current symptoms are unlikely to be caused by functional abdominal bloating/distension. Consider further assessment as clinically indicated. Also, see pearls and pitfalls above.
If meets diagnosis (positive):
Likely diagnosis of functional abdominal bloating and distension. Consider initiating treatment.
Studies of therapies in functional abdominal bloating/distension are limited. Many of the treatments that can be trialed have been studied in other disorders of gut brain interactions.
Treatments may include:
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Dietary modifications.
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Simethicone.
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Peppermint oil.
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Neuromodulators (e.g. tricyclic antidepressants).
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Probiotics.
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Antibiotics (e.g. rifaximin).
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Abdominal (diaphragmatic) breathing exercises to treat abdominophrenic dyssynergia.
The choice of therapy is outside the scope of this calculator and will depend on clinical context.
This calculator should only be used in patients who do not have signs or symptoms suggestive of a structural/mechanical, metabolic or systemic cause of their symptoms based on clinical history, physical exam and initial work-up.