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    Rome IV Diagnostic Criteria for Functional Chest Pain

    Official Rome IV criteria for the diagnosis of functional chest pain.

    INSTRUCTIONS

    Use in patients with symptoms suggestive of functional chest pain such as recurrent, unexplained chest pain or discomfort for at least 6 months.

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

    • Symptoms suggestive of cardiac ischemia.

    • Dysphagia.

    • Unexplained iron deficiency anemia.

    • Unintentional weight loss.

    • Palpable cervical lymphadenopathy on exam.

    • Persistent vomiting.

    When to Use
    Pearls/Pitfalls
    Why Use

    Patients presenting with recurrent, unexplained chest pain or discomfort for at least the past 6 months which are suggestive of functional chest pain. The diagnosis of functional chest pain should only be made after cardiac causes are ruled out and esophageal workup is otherwise non-diagnostic.

    • Cardiac causes must be excluded.

    • Given the high prevalence of gastroesophageal reflux disease (GERD) with non-cardiac chest pain, a trial of high dose proton pump inhibitor (PPI) therapy can be considered to determine whether GERD may trigger symptoms.

    • Ambulatory reflux monitoring can be considered in patients who do not respond to PPI therapy.

    • If upper endoscopy is pursued, biopsies should be obtained to assess for eosinophilic esophagitis.

    • Once GERD has been ruled out, esophageal manometry should be considered to assess for presence of a major esophageal motility disorder.

    • Psychiatric diagnoses (e.g. anxiety and depression) are common in functional chest pain.

    • Helps to make a diagnosis of functional chest pain when cardiac causes are ruled out and appropriate workup (which may include assessment for GERD, eosinophilic esophagitis, and major esophageal motility disorders) is nondiagnostic.

    • Helps to guide management of symptoms once a diagnosis of functional chest pain is established.

    Must have the following:

    For 3 months prior with symptom onset ≥6 months ago with a frequency of at least once a week

    Diagnostic Result:

    Please fill out required fields.

    Next Steps
    Evidence
    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
    • David Cangemi, MD
    Reviewed By
    • Jan Track, MD, PhD, RFF
    About the Creator
    Dr. Douglas Drossman
    Dr. Lin Chang
    The Rome Foundation
    Content Contributors
    • David Cangemi, MD
    Reviewed By
    • Jan Track, MD, PhD, RFF