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    Rome IV Diagnostic Criteria for Dyspepsia

    Official Rome IV criteria for the diagnosis of functional dyspepsia.

    INSTRUCTIONS

    Use in patients with symptoms suggestive of functional dyspepsia such as chronic and recurrent epigastric pain, discomfort, fullness, burning and early satiety for at least 6 months.

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

    • Signs or symptoms of GI bleeding.
    • Unexplained iron deficiency anemia.
    • Unintentional weight loss.
    • Palpable abdominal mass or lymphadenopathy on exam.
    • Family history of gastric cancer and no recent upper endoscopy.
    • Dysphagia.
    • Persistent vomiting.
    When to Use
    Pearls/Pitfalls
    Why Use

    Patients presenting with recurrent upper GI symptoms suggestive of dyspepsia for at least the past 6 months.  The diagnosis of functional dyspepsia should be made by clinical history, physical examination, minimal laboratory tests, and a normal upper endoscopy. 

    • Developed to diagnose functional dyspepsia in patients presenting with bothersome upper GI symptoms.
    • A diagnosis of functional dyspepsia can only be made after a careful diagnostic workup reveals no evidence of organic, systemic, or metabolic disease to explain the symptoms. Workup should include upper endoscopy and evaluation for the presence of Helicobacter pylori infection (and treatment if positive).
    • Patients who meet criteria for functional dyspepsia without an upper endoscopy being performed are considered uninvestigated dyspepsia. 
    • Gastroesophageal reflux disease (GERD) may overlap with functional dyspepsia, but GERD and functional dyspepsia are distinct disorders.
    • There are two subtypes of functional dyspepsia each with its own criteria: post-prandial distress syndrome, which is related to meals, and epigastric pain syndrome, which may or may not be related to meals.

    • Helps to make a diagnosis of functional dyspepsia when appropriate workup of upper GI symptoms is nondiagnostic.
    • Helps to distinguish symptoms from other common disorders, such as GERD.
    • Helps to guide management of functional dyspepsia based on subtype (post-prandial distress syndrome vs. epigastric pain syndrome).

    Must have ≥1 of the following:

    For 3 months prior with symptom onset ≥6 months ago

    Must also have the following:

    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 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

    Are you Dr. Douglas Drossman? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Colleen Parker, MD
    • David Cangemi, MD
    Reviewed By
    • William D. Chey (Rome Foundation)
    About the Creator
    Dr. Douglas Drossman
    Are you Dr. Douglas Drossman?
    Guidelines
    Content Contributors
    • Colleen Parker, MD
    • David Cangemi, MD
    Reviewed By
    • William D. Chey (Rome Foundation)