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    Rome IV Diagnostic Criteria for Centrally Mediated Abdominal Pain Syndrome (CAPS)

    Official Rome IV criteria for the diagnosis of centrally mediated abdominal pain syndrome (CAPS).


    Use in patients with chronic abdominal pain that is poorly related to gut function for at least 6 months.

    Patients with any of the following features must be evaluated clinically for other diagnoses to explain their abdominal pain even though centrally mediated abdominal pain syndrome 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 GI cancer.

    • Onset of symptoms age ≥50 years and have not had age-appropriate colon cancer screening.

    • Sudden or acute onset or new change in bowel habit.

    • Recurrent nausea and vomiting.

    When to Use
    Why Use

    Use in patients with chronic abdominal pain that is constant or frequently occurring for at least the last 6 months. This pain is poorly related to gastrointestinal functions such as eating and defecation. There is no structural or metabolic cause for the abdominal pain. In addition there is no other disorder of gut-brain interaction that can be diagnosed. A diagnosis is based on history, physical examination and limited investigations.

    • Centrally mediated abdominal pain syndrome is also known as chronic idiopathic abdominal pain or functional abdominal pain syndrome.

    • Chronic abdominal pain is the hallmark of centrally mediated abdominal pain syndrome. 

    • For women, the abdominal pain should not exclusively occur during their menses.

    • The abdominal pain in centrally mediated abdominal pain syndrome is often severe and has an impact on a patient’s daily functioning.

    • If the abdominal pain is associated with meals, defecation, or altered bowel habits, consider a diagnosis of irritable bowel syndrome.

    • If the abdominal pain is located in the upper abdomen and associated with meals, consider a diagnosis of functional dyspepsia (epigastric pain syndrome and/or postprandial distress syndrome).

    • If the patient has a positive Carnett’s sign, has point tenderness, or the pain is worsened by movement or activity, consider abdominal wall pain.

    • If the patient is taking increasing doses of opioids, consider narcotic bowel syndrome.

    • If the patient has had an adequate initial evaluation, including abdominal imaging, focus on the management of the pain rather than further diagnostic evaluation. Increasing or unremitting abdominal pain does not require further testing.

    • To establish a diagnosis of centrally mediated abdominal pain syndrome in patients presenting with chronic and continuous or nearly continuous abdominal pain.

    • Establishing a diagnosis of centrally mediated abdominal pain syndrome can aid in discussion regarding the pathophysiology of a patient’s symptoms and management options.

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