A modification of the diagnostic criteria for disorders of gut-brain interaction (DGBI) for use in clinical practice has been proposed by the Rome Foundation, as reported in Gastroenterology.
The modification of the Rome IV diagnostic criteria was developed to address the discrepancy between their use as research criteria and for clinical diagnoses.
The research group recommended that the following be fulfilled to meet Rome Foundation clinical criteria:
- Qualitative Symptom Criteria: The qualitative features of the Rome IV criteria need to be met.
- Bothersomeness: Patients should have sufficiently bothersome symptoms that require them to seek care or have symptoms that affect daily activity (personal and professional); the symptoms should be severe enough to affect their quality of life. For this criterion, the clinician would endorse: “Patients report the symptoms as bothersome.”
- Frequency Criteria: A lower than Rome IV threshold frequency is permitted, provided that the symptoms are bothersome enough to interfere with daily activity or require treatment.
- Duration Criteria: The Rome IV requirement of 6 months duration of symptoms is not required. To provide some assurance that other diagnoses have been excluded, the research group suggests that symptoms be present for the previous 8 weeks before seeking care. Exceptions to the duration requirement are: (1) when the clinician needs to make an earlier diagnosis and is satisfied that the medical evaluation excludes other disease or (2) for diagnoses in which the symptoms occur infrequently and intermittently (eg, cyclic vomiting syndrome, abdominal migraine, biliary pain, and proctalgia fugax).
“The use of these criteria assumes that other diagnoses have been sufficiently ruled out based on the clinical presentation and additional investigations when needed,” according to the investigators. “These criteria do not replace the standard Rome IV criteria for clinical trials [and] epidemiological or pathophysiological studies.”
Application of these criteria for clinical practice and communicating the diagnosis with confidence will improve patient acceptance, reduce unnecessary diagnostic studies, and enhance the patient-provider relationship, according to the Rome Foundation.
Future research is needed to determine whether any minimal thresholds for bothersomeness and frequency and duration of symptoms can be identified for clinical practice criteria for specific DGBIs, noted the researchers.
The proposed criteria for patient care includes lists for a number of specific esophageal disorders, gastroduodenal disorders, bowel disorders, centrally mediated disorders of gastrointestinal pain, gallbladder and sphincter of Oddi disorders, anorectal disorders, childhood functional gastrointestinal disorders for neonates and toddlers, and childhood functional gastrointestinal disorders for children and adolescents.
“The clinical criteria proposed can serve as a basis for studies to validate their application in clinical practice,” stated the investigators. “The data from future studies will then be applied and implemented in the upcoming Rome V consensus.”
Drossman DA, Tack J. Rome Foundation clinical diagnostic criteria for disorders of gut-brain interaction (DGBI). Gastroenterol. 2022;162(1):300-315. doi: 10.1053/j.gastro.2021.11.019