MDCalc

Rome IV Diagnostic Criteria for Functional Dysphagia

Official Rome IV criteria for the diagnosis of functional dysphagia.

Use in patients with symptoms suggestive of functional dysphagia, such as a recurrent sense of solid and/or liquid foods passing abnormally through the esophagus, for at least 6 months.

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

  • Odynophagia.

  • Sore throat.

  • Heartburn or esophageal reflux/regurgitation.

  • Unexplained iron deficiency anemia.

  • Unintentional weight loss.

  • Palpable cervical lymphadenopathy on exam.

  • Persistent vomiting.

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

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Advice

If diagnostic criteria are not met (negative):

Symptoms are unlikely to be caused by functional dysphagia. Consider further assessment for other diseases, or a different functional GI disorder.

If meets diagnosis (positive):

Likely diagnosis of functional dysphagia.

Management

Management of functional dysphagia may include:

  • Proton pump inhibitors to treat complications of GERD when present.

  • Empiric endoscopic esophageal dilation for subtle esophageal ring or stricture which may explain the dysphagia symptoms.

  • Neuromodulators (i.e. tricyclic antidepressants).

Critical Actions

This calculator should only be used in patients after appropriate organic, systemic, and metabolic causes have been ruled out after careful investigation.