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    Rome IV Diagnostic Criteria for Child Functional Dyspepsia

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

    INSTRUCTIONS

    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.

    When to Use
    Pearls/Pitfalls
    Why Use

    Children and adolescents presenting with recurrent upper gastrointestinal symptoms suggestive of dyspepsia such as chronic and recurrent epigastric pain or burning not associated with defecation, postprandial fullness, early satiety, upper abdominal bloating, nausea and/or excessive belching for at least 2 months.

    • The diagnosis of  functional dyspepsia (FD) is a positive diagnosis, and not a diagnosis of exclusion. It should be evaluated and treated in the context of the biopsychosocial model.

    • There are two subtypes of FD each with its own criteria: postprandial distress syndrome, which is related to meals, and epigastric pain syndrome, which may or may not be related to meals.

    • A negative EGD is not needed to make the diagnosis of pediatric functional dyspepsia (unlike in adults). 

    • Unlike in adults, the association of H. pylori gastritis and pediatric FD has not been well established. Therefore, routine screening for H. pylori in children with FD is currently not indicated. 

    • Symptoms of FD often overlap with gastroesophageal reflux disease, gastroparesis, functional constipation, and irritable bowel syndrome, which should be addressed. 

    • Anxiety is higher in children with FD compared to those without dyspepsia, both in the short and long-term.

    • Used to establish the diagnosis of functional dyspepsia in children and adolescents who present with recurrent or chronic epigastric pain or bothersome postprandial symptoms. 

    • Can be used to discuss the diagnosis of functional dyspepsia with patients and initiate treatment based on FD subtypes.

    • Making a diagnosis will help minimize unnecessary diagnostic evaluations and allow early, targeted treatment.  

    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:

    Please fill out required fields.

    Next Steps
    Evidence
    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
    • Beate Beinvogl, MD, MPH
    Reviewed By
    • Samuel Nurko, MD, MPH
    About the Creator
    Dr. Douglas Drossman
    Dr. Lin Chang
    The Rome Foundation
    Content Contributors
    • Beate Beinvogl, MD, MPH
    Reviewed By
    • Samuel Nurko, MD, MPH