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    Chief Complaint


    Organ System


    Patent Pending

    Rome IV Diagnostic Criteria for Narcotic Bowel Syndrome

    Official Rome IV criteria for the diagnosis of narcotic bowel syndrome.


    Use in patients with onset or increase of chronic abdominal pain treated with narcotics in which the pain worsens or does not resolve.

    Patients with any of the following features must be evaluated clinically for other diagnoses even though narcotic bowel 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 of new change in bowel habit.

    When to Use
    Why Use

    Patients with onset or increase of chronic abdominal pain treated with narcotics in which the pain worsens or does not resolve may have a diagnosis of narcotic bowel syndrome. Patients with narcotic bowel syndrome may have other gastrointestinal or other medical or surgical diagnoses. This diagnosis is made based on history, clinical exam and diagnostic testing as required.

    • Narcotic bowel syndrome is also known as opioid-induced gastrointestinal hyperalgesia.

    • It occurs in about 5% of patients on chronic opioids.

    • The abdominal pain is not fully explained by either a current or previous gastrointestinal diagnosis. Patients can have another diagnosis but the pain is not fully explained by that condition (e.g. Crohn’s disease in endoscopic remission but with ongoing pain in the setting of opioid use).

    • Narcotics may initially provide temporary relief of abdominal pain and then worsen as the narcotic wears off (soar and crash).

    • Over time, the pain becomes chronic even with opioid treatment.

    • Abdominal pain in this condition is often poorly localized. 

    • The pain in narcotic bowel syndrome may be associated with other gastrointestinal symptoms such as nausea, constipation, etc. that have been associated with opioid use.

    • There is no dosage of opioid that needs to be met to make this diagnosis. 

    • If the pain improves after narcotic detoxification would confirm the diagnosis of narcotic bowel syndrome.

    • Establishing a diagnosis of narcotic bowel syndrome will help facilitate discussions with patients regarding the nature of their symptoms.

    • Understanding narcotic bowel syndrome as a cause of symptoms will help guide further management.

    Must have the following:

    For 3 months prior with symptom onset ≥6 months ago

    Must have ≥2 of the following:

    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