The Rome Foundation continues to actively educate clinicians worldwide on the new Rome IV criteria in order to expand their understanding of functional GI disorders and help them deliver quality patient care.

Here are five things clinicians should know about Rome IV:

  1. Expanded understanding of FGID’s to new definition: Disorders of gut-brain interaction. The definition of FGIDs changed with Rome III from the prior absence of structural disease to a more appropriate disorder of GI functioning. Now to reach a more scientific and clinically meaningful approach to these disorders, Rome IV expanded upon the concept with an agreed-upon definition: Disorders of gut-brain interaction. These disorders are classified by GI symptoms related to any combination of:
  • Motility disturbance
  • Visceral hypersensitivity
  • Altered mucosal and immune function
  • Altered gut microbiota
  • Altered central nervous system (CNS) processing

This definition is most consistent with our evolving understanding of multiple pathophysiological processes that, in part or together, determine the symptom features that characterize the Rome classification of disorders. We believe it to be readily understood and acceptable to clinicians, academicians, regulatory agencies, the pharmaceutical industry, and to patients.

  1. The addition of new diagnoses with known etiologies under Rome IV. These now include:
  • Reflux hypersensitivity syndrome (esophageal disorders chapter) where there is heartburn with normal physiological degrees of reflux
  • Cannabinoid hyperemesis (gastroduodenal disorder chapter), episodes of vomiting like cyclic vomiting syndrome caused by cannabis
  • Narcotic bowel syndrome (Centrally Mediated Disorders of Gastrointestinal Pain chapter) which is centrally mediated hyperalgesia from opioids
  • Opioid-induced constipation (Bowel disorders chapter) which relates to the peripheral effects of opioids on producing constipation


  1. New chapters have been added to meet our growing understanding of these disorders:
  • Intestinal Microenvironment and the Functional Gastrointestinal Disorders combines knowledge of the microbiome, food, and nutrition to improve understanding of the luminal aspects of GI function.
  • Pharmacological and Pharmacokinetic Aspects of Functional GI Disorders has been changed to Pharmacological, Pharmacokinetic, and Pharmacogenomic Aspects of Functional Gastrointestinal Disorders to include the role of genetics in the clinical response to pharmaceutical treatments.
  • Gender, Age, Society, Culture and the Patient’s Perspective has been split into two articles to reflect the rapid growth of knowledge in these areas: Age, Gender, Women’s Health, and the Patient, and multicultural aspects of Functional Gastrointestinal Disorders.
  • Biopsychosocial Aspects of Functional Gastrointestinal Disorders has been changed from Psychosocial Aspects of Functional Gastrointestinal Disorders to reflect the multidetermined nature of biopsychosocial processes.
  • Centrally Mediated Disorders of Gastrointestinal Pain has been changed from Functional Abdominal Pain Syndrome in Rome III to reflect the predominant CNS contribution to the symptoms.


  1. Revised Sphincter of Oddi Disorder (SOD) Criteria. Recommendations to perform biliary sphincterotomy based on clinical criteria (biliary dilatation and increased liver chemistries or increased pancreatic enzyme levels) for presumed sphincter of Oddi pain has not had convincing supportive evidence. Thus, balancing the benefits of symptomatic relief with the potential risks of pancreatitis, bleeding, and perforation has been challenging, and the Rome III criteria for them were not particularly helpful in providing proper guidelines. Now, driven by evidence that debunks the value of sphincterotomy for type III SOD, the chapter committee has reclassified these disorders, and they provide a more rational treatment algorithm. The previous type III SOD categorization of the Milwaukee classification has been removed.


  1. The new diagnosis B3a Chronic Nausea Vomiting Syndrome combines the previous Rome III entities Chronic Idiopathic Nausea and Functional Vomiting. This owes to a lack of evidence delineating different diagnostic approaches and management of nausea compared with vomiting, and the clinical observation that these two symptoms commonly are associated. Although we recognize patients may present only with nausea, the clinical approach to diagnosis and management remains the same.

Related Resources

Video: Dr. Douglas Drossman sat down with Adam Marcus of Gastroenterology & Endoscopy News at Digestive Disease Week 2016 to discuss the new Rome IV guidelines.