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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.

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