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    Rome IV Diagnostic Criteria for Dyspepsia

    Provides criteria for diagnosis of dyspepsia.
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    INSTRUCTIONS

    • Use in patients with recurrent upper GI symptoms on average once weekly in the last 3 months with symptom onset ≥6 months ago and no abnormalities on diagnostic testing, including upper endoscopy.
    • Do NOT use in patients with alarm symptoms such as GI bleeding, unexplained iron deficiency anemia, unintentional weight loss, palpable abdominal mass, family history of colon cancer or symptom onset ≥50 years of age and not yet screened for colon cancer, or sudden/acute onset of new change in bowel habit.
    When to Use
    Pearls/Pitfalls
    Why Use
    • Patients with recurrent upper GI symptoms on average once weekly in the last 3 months with symptom onset ≥6 months ago and no abnormalities on diagnostic testing, including upper endoscopy.
    • Do NOT use in patients with alarm symptoms such as:
      • Unexplained iron deficiency anemia.
      • Signs or symptoms of gastrointestinal bleeding.
      • Unintentional weight loss.
      • Palpable abdominal mass or lymphadenopathy on exam.
      • Family history of colon cancer and have not had age-appropriate colon cancer screening.
      • 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.

    • Developed to diagnose functional dyspepsia in patients presenting with upper GI tract symptoms.  

    • A diagnosis of functional dyspepsia can only be made when there is no evidence of organic, systemic, or metabolic disease to explain the symptoms. This includes workup with upper endoscopy and evaluation for the presence of Helicobacter pylori infection (and treatment if positive).

    • There are two subtypes of functional dyspepsia: post-prandial distress syndrome and epigastric pain syndrome. These criteria are used to differentiate between the two.

    • Helps to make a diagnosis when standard workup of upper gastrointestinal tract symptoms is negative.

    • Helps guide conversations with patients about the diagnosis of functional dyspepsia and typical symptoms.

    • May help 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

    Advice

    If diagnosis not met (negative):

    Symptoms are unlikely to be caused by functional dyspepsia. Consider further assessment for other pathology or a different functional gastrointestinal disease diagnosis.

    If meets diagnosis (positive):

    Likely diagnosis of functional dyspepsia. Consider management per current American College of Gastroenterology (ACG) guidelines.

    Management

    • Management of functional dyspepsia may include:
      • Proton pump inhibitor (PPI).
      • Tricyclic antidepressant.
      • Prokinetic medications.
      • Psychological therapy.
    • Consult ACG guidelines for further details.

    Critical Actions

    • This calculator should only be used for patients in which organic, systemic, or metabolic causes of their symptoms have been ruled out on routine investigations (which includes upper endoscopy).

    • Note: other GI conditions (such as gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), etc) may coexist with functional dyspepsia.

    Formula

    Step 1. Determine if criteria for functional dyspepsia are met. Must fulfill both the following criteria for the last 3 months with symptom onset ≥6 months ago:

    1. ≥1 of the following:

      1. Bothersome postprandial fullness.

      2. Bothersome early satiation.

      3. Bothersome epigastric pain.

      4. Bothersome epigastric burning.

    2. No evidence of organic, systemic, metabolic or structural disease (including on upper endoscopy) that is likely to explain the symptoms.

    Step 2. If above criteria are met, then determine subtype:

    Postprandial Distress Syndrome:

    Must include one or both of the following at least 3 days per week:

    1. Bothersome postprandial fullness

    2. Bothersome early satiation

    Epigastric Pain Syndrome:

    Must include one or both of the following at least 1 day per week:

    1. Bothersome epigastric pain

    2. Bothersome epigastric burning

    *Note: patients may be positive for both postprandial distress syndrome AND epigastric pain syndrome

    Evidence Appraisal

    The Rome criteria were initially developed as a way to classify and diagnose the various functional gastrointestinal disorders such as dyspepsia, functional constipation and irritable bowel syndrome (IBS) based primarily on symptoms. The updated Rome IV was designed to make the criteria easier to use clinically, incorporate investigations where appropriate and psychosocial aspects of these disorders, and improve its applicability to other countries and cultures.

    The development of the Rome IV questionnaires began with a survey of 1,162 adults without gastrointestinal disorders to determine the frequency in the US general population of various gastrointestinal symptoms. The 90th percentile of symptom frequency was used to define what was considered abnormal. Based on this, diagnostic questionnaires were created and reviewed by clinical experts. These questionnaires were validated in 843 patients from gastroenterology clinics. In functional dyspepsia, the sensitivity of these criteria was 54.7% and the specificity was 93.3%.  

    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

    Content Contributors
    • Colleen Parker, MD
    About the Creator
    Dr. Douglas Drossman
    Content Contributors
    • Colleen Parker, MD