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    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.

    When to Use
    Why Use

    Patients presenting with symptoms of a recurrent sense of solid and/or liquid foods passing abnormally through the esophagus for at least 6 months, which are suggestive of functional dysphagia. The diagnosis of functional dysphagia should be made only after oropharyngeal mechanisms of dysphagia, structural lesions in the esophagus, gastroesophageal reflux disease, eosinophilic esophagitis, and major esophageal motility disorders have been excluded.

    • Oropharyngeal dysphagia should be excluded.

    • Gastroesophageal reflux disease and eosinophilic esophagitis (EoE) should be excluded with an upper endoscopy (and biopsy to rule out EoE) and a trial of proton pump inhibitor therapy.

    • Barium contrast studies may be considered to rule out structural abnormalities (e.g. esophageal stricture, web or paraesophageal hernia).

    • In the absence of structural lesions by barium swallow or upper endoscopy, esophageal manometry is performed to exclude major motor disorders (e.g. achalasia, diffuse esophageal spasm). Borderline or minor motor disorders remain compatible with a diagnosis of functional dysphagia. 

    • In some cases, dysphagia may be due to subtle esophageal abnormalities such as a ring or web not seen by imaging. In this situation, empiric esophageal dilation may improve the dysphagia.

    • Helps to make a diagnosis of functional dysphagia when appropriate workup is otherwise nondiagnostic.

    • Helps to distinguish symptoms from other common disorders, such as complications of GERD (e.g. stricture) and major motility disorders.

    • Helps to guide management of symptoms once a diagnosis of functional dysphagia 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
    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
    • William D. Chey, MD, AGAF, FACG, FACP
    About the Creator
    Dr. Douglas Drossman
    Dr. Lin Chang
    The Rome Foundation
    Content Contributors
    • David Cangemi, MD
    Reviewed By
    • Jan Track, MD, PhD, RFF
    • William D. Chey, MD, AGAF, FACG, FACP