MDCalc

Rome IV Diagnostic Criteria for Child Functional Dyspepsia

Official Rome IV criteria for the diagnosis of child functional dyspepsia.

Use in a child or adolescent with symptoms suggestive of functional dyspepsia for at least 2 months. The diagnosis of functional dyspepsia should be made by clinical history, positive symptom criteria, physical examination, minimal diagnostic testing as clinically indicated.  

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

  • Persistent right upper or right lower quadrant pain.

  • Dysphagia.

  • Odynophagia.

  • Persistent vomiting.

  • Gastrointestinal blood loss.

  • Nocturnal pain or diarrhea.

  • Arthritis.

  • Perirectal disease.

  • Involuntary weight loss.

  • Deceleration of linear growth.

  • Delayed puberty.

  • Unexplained fever.

  • Family history of inflammatory bowel disease, celiac disease, or peptic ulcer disease.

Must have ≥1 of the following:

For ≥4 days per month for ≥2 months prior

Additional criteria for child postprandial distress syndrome:

Must have the following for ≥2 months prior

Additional criteria for child epigastric pain syndrome:

Must have the following for ≥2 months prior

Diagnostic Result

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Advice

If diagnosis not met (negative):

Current symptoms are unlikely to be related to functional dyspepsia. Consider further assessment as clinically indicated. Also, see pearls and pitfalls above. 

If meets diagnosis (positive):

Likely diagnosis of functional dyspepsia. Determine the subtype and consider initiating treatment.

Management

Management of both functional dyspepsia subtypes include: 

  1. Education about the diagnosis and the current understanding of disorders of the gut-brain interaction, providing reassurance.

  2. Dietary changes can be tried as a first step: smaller meals, avoidance of fatty meals, spicy foods, and carbonated beverages as well as avoidance of nonsteroidal anti-inflammatory agents. 

  3. Addressing anxiety or psychological stressors as the cause or result of the gastrointestinal symptoms.

Further management is primarily supportive and may vary depending on the subtype.

For postprandial distress syndrome (PDS):

  • Cyproheptadine.

  • Prokinetics  (e.g. erythromycin, prucalopride, cisapride*, domperidone*, metoclopramide*).

  • Buspirone.

  • Mirtazapine.

  • Antiemetics (e.g. Ondansetron, prochlorperazine, promethazine, diphenhydramine).

  • Psychological treatments (e.g. CBT, hypnosis, mindfulness).

  • Herbal treatments (e.g. Iberogast, caraway and peppermint oil based formulations). 

  • Neurostimulator (IB-Stim).

  • Botulinum toxin to pylorus..

For epigastric pain syndrome (EPS):

  • Short term PPI or H2 blockers.

  • Cyproheptadine.

  • Pain modulators such as gabapentin or pregabalin, tricyclic antidepressants (e.g. Amitriptyline).

  • Psychological treatments (e.g. CBT, hypnosis, mindfulness).

  • Herbal treatments (e.g. Iberogast, caraway and peppermint oil based formulations). 

  • Neurostimulator (IB-Stim).

  • Botulinum toxin to pylorus.

No pediatric clinical guidelines for evaluation or treatment of child functional dyspepsia are available. 

The choice of therapy is outside the scope of this calculator and will depend on clinical context.

Some of the pharmacologic interventions have not been studied in children and/or adolescents and can only be used off-label.

*Available only through a special Investigational New Drug program (IND) given side effect profile, particularly possible QTc prolongation.

Critical Actions

This calculator should only be used in patients who do not have signs or symptoms suggestive of a structural, metabolic or other systemic cause of their symptoms based on clinical history, physical exam, and initial work-up.

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