The Rome process and Rome criteria are an international effort to create scientific data to help in the

diagnosis Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". In systems engin ...

and treatment of

functional gastrointestinal disorder Functional gastrointestinal disorders (FGID), also known as disorders of gut–brain interaction, include a number of separate idiopathic disorders which affect different parts of the gastrointestinal tract and involve visceral hypersensitivity ...

s, such as irritable bowel syndrome, functional dyspepsia and rumination syndrome. The Rome diagnostic criteria are set forth by Rome Foundation, a

not for profit A nonprofit organization (NPO) or non-profit organisation, also known as a non-business entity, not-for-profit organization, or nonprofit institution, is a legal entity organized and operated for a collective, public or social benefit, in co ...

501(c)(3) organization based in

Raleigh, North Carolina Raleigh (; ) is the capital city of the state of North Carolina and the List of North Carolina county seats, seat of Wake County, North Carolina, Wake County in the United States. It is the List of municipalities in North Carolina, second-most ...

, United States.

History

Several systematic approaches attempted to classify

s (FGIDs). As a result, there were several key events which ultimately led to the current Rome Classification. In 1962, Chaudhary and Truelove published their study of IBS patients in Oxford, England. This was the first attempt to classify the new field of functional gastrointestinal disorders. Much of what they reported has persisted to the present day. Subsequently, in 1978 came the "Manning Criteria" developed by Heaton and colleagues in Bristol. This characterized IBS-D (IBS with predominant diarrhea), but importantly, a cluster of symptoms which were characteristic for this disorder. This ultimately became the basis for Rome's symptom-based criteria for IBS. From 1980 to 1994, there were several epidemiological and clinical studies evaluating symptom prevalence and frequency in healthy subjects and IBS patients. Thompson, Drossman, Talley, Whitehead, and Kruis.Torsoli A, Corazziari E. The WTR's, the Delphic Oracle and the Roman Conclaves Gastroenterol Int 1991;4:44–45.Drossman DA, Sandler RS, McKee DC, et al. Bowel patterns among subjects not seeking health care. Use of a questionnaire to identify a population with bowel dysfunction. Gastroenterology 1982;83:529–534.Sandler RS, Drossman DA, Nathan HP, et al. Symptom complaints and health care seeking behavior in subjects with bowel dysfunction. Gastroenterology 1984;87:314–318.Talley NJ, Phillips SF, Melton LJ, et al. A patient questionnaire to identify bowel disease. Ann Intern Med 1989;111:671–674Kruis W, Thieme CH, Weinzierl M, et al. A diagnostic score for the irritable bowel syndrome. Its value in the exclusion of organic disease. Gastroenterology 1984;87:1–7.Drossman DA. Diagnosis of the irritable bowel syndrome: A simple solution? Gastroenterology 1984;87:224–225 In 1989, the first consensus-based diagnostic criteria for IBS were established.Thompson WG, Dotevall G, Drossman DA, et al. Irritable bowel syndrome: Guidelines for the diagnosis. Gastroenterol Int 1989;2:92–95. The following year, a classification system for FGIDs was established.Drossman DA, Thompson WG, Talley NJ, et al. Identification of subgroups of functional bowel disorders. Gastroenterol Int 1990;3:159–172. From 1991 to 1993, several working teams (esophagus, gastroduodenal, bowel, biliary, anorectal) published symptom-based criteria and clinical features of the functional GI disorders within these anatomic domains in ''Gastroenterology International''.Richter JE, Baldi F, Clouse RE, et al. Functional oesophageal disorders. Gastroenterol Int 1992;5:3–17Talley NJ, Colin-Jones D, Koch KL, et al. Functional dyspepsia: a classification with guidelines for diagnosis and management. Gastroenterol Int 1991;4:145–160Thompson WG, Creed F, Drossman DA, et al. Functional bowel disorders and chronic functional abdominal pain. Gastroenterol Int 1992;5:75–91Corazziari E, Funch-Jensen P, Hogan WJ, et al. Working team report: functional disorders of the biliary tract. Gastroenterol Int 1993;6:129–144.Whitehead WE, Devroede G, Habib FI, et al. Functional disorders of the anorectum. Gastroenterol Int 1992;5:92–108.Talley NJ, Nyren O, Drossman DA, et al. The irritable bowel syndrome: toward optimal design of controlled treatment trials. Gastroenterol Int 1993;4:189–211 In 1993, a validated questionnaire of all the diagnostic criteria was created and was then applied in a national survey, the US Householder Survey: the first national epidemiological database on the prevalence, demographic factors, and health care seeking features of people with FGIDs.Drossman DA, Li Z, Andruzzi E, et al. U.S. householder survey of functional gastrointestinal disorders: prevalence, sociodemography and health impact. Dig Dis Sci 1993;38:1569–1580. In 1994, FGIDs were categorized into anatomical domains and resulted in a book now recognized as Rome I – ''The Functional Gastrointestinal Disorders: Diagnosis, Pathophysiology and Treatment – A Multinational Consensus''.Drossman DA, Richter JE, Talley NJ, et al. The functional gastrointestinal disorders: diagnosis, pathophysiology and treatment. McLean (VA): Degnon Associates, 1994. The Rome criteria have been evolving from the first set of criteria issued in 1989 (The Rome Guidelines for IBS) through the Rome Classification System for functional gastrointestinal disorders (1990), or Rome-1, the Rome I Criteria for IBS (1992) and the functional gastrointestinal disorders (1994), the Rome II Criteria for IBS (1999) and the functional gastrointestinal disorders (1999) to the Rome III Criteria (2006). "Rome II" and "Rome III" incorporated

pediatric Pediatrics ( also spelled ''paediatrics'' or ''pædiatrics'') is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, paediatrics covers many of their youth until the ...

criteria to the consensus. The Rome IV update was published 10 years later in May 2016. This covers epidemiology, pathophysiology, psychosocial and clinical features, and diagnostic evaluation and treatment recommendations for 33 adult and 17 pediatric functional gastrointestinal disorders.

Process

The Rome criteria are achieved and finally issued through a consensual process, using the

Delphi method } The Delphi method or Delphi technique ( ; also known as Estimate-Talk-Estimate or ETE) is a structured communication technique or method, originally developed as a systematic, interactive forecasting method which relies on a panel of experts. The ...

(or Delphi technique). The Rome Foundation process is an international effort to create scientific data to help in the diagnosis and treatment of functional gastrointestinal disorders, also known as disorders of gut-brain interaction.Drossman DA. The Rome IV Committees, editor. Functional Gastrointestinal Disorders and the Rome IV process. In: Drossman DA, Chang L, Chey WD, Kellow J, Tack J, Whitehead WE, editors. Rome IV functional gastrointestinal disorders: disorders of gut-brain interaction. I. Raleigh, NC: The Rome Foundation; 2016. pp. 1–32. The Rome Diagnostic criteria are set forth by the Rome Foundation, an independent, not for profit 501(c)(3) organization.

The Rome Foundation

The Rome Foundation, incorporated in 1996 and based in Raleigh, North Carolina, is an independent not for profit 501(c) 3 organization. The foundation provides support for activities which foster clinical research, data and educational information which aid in the diagnosis and treatment of functional gastrointestinal disorders."Meet the Rome Foundation," 2017. Retrieved from https://theromefoundation.org/wp-content/uploads/Meet-The-Rome-Foundation-2017-web.pdf Over the last 25 years, the Rome organization has sought to legitimize and update the knowledge of functional GI disorders. This has been accomplished by bringing together scientists and clinicians from around the world to classify and critically appraise the science of gastrointestinal function and dysfunction. This knowledge permits clinical scientists to make recommendations for diagnosis and treatment that can be applied in research and clinical practice. The mission is to improve the lives of people with these disorders. The goals of the Rome Foundation are to promote global recognition and legitimization of FGIDs, advance the scientific understanding of their pathophysiology, optimize clinical management for these patients and develop and provide educational resources to accomplish these goals.

Definition of functional gastrointestinal disorders/disorders of gut-brain interaction

''See also: ''

Functional gastrointestinal disorder Functional gastrointestinal disorders (FGID), also known as disorders of gut–brain interaction, include a number of separate idiopathic disorders which affect different parts of the gastrointestinal tract and involve visceral hypersensitivity ...

'' Using the Delphi method, the Rome Foundation and its board of directors, chairs and co-chairs of the ROME IV committees developed the current definition for disorders of gut-brain interaction. A group of disorders classified by GI symptoms related to any combination of: * Motility disturbance *

Visceral hypersensitivity Visceral pain is pain that results from the activation of nociceptors of the thoracic, pelvic, or abdominal viscera (organs). Visceral structures are highly sensitive to distension (stretch), ischemia and inflammation, but relatively insensitive t ...

* Altered mucosal and immune function * Altered

gut microbiota Gut microbiota, gut microbiome, or gut flora, are the microorganisms, including bacteria, archaea, fungi, and viruses that live in the digestive tracts of animals. The gastrointestinal metagenome is the aggregate of all the genomes of the gut m ...

* Altered

central nervous system The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain and spinal cord. The CNS is so named because the brain integrates the received information and coordinates and influences the activity of all par ...

(CNS) processing

Evolution of Rome criteria

Rome I

In 1994, Rome I was published as The Functional Gastrointestinal Disorders:Diagnosis, Pathophysiology, and Treatment—A Multinational Consensus.

Rome II

By the mid-1990s, the concept of FGID classification and the use of diagnostic criteria was promoted due to the US Food and Drug Administration (FDA) recommended the use of the IBS criteria for selection into pharmaceutical studies, and the pharmaceutical companies took interest in supporting the efforts of the Rome Foundation to improve the understanding, diagnosis, and treatment of FGIDs and to also apply the use of these criteria in their pharmaceutical studies. In Rome II, the pediatric population of FGIDs was added.

Rome III

After publication of Rome II, the number of studies published using the Rome criteria in clinical trials grew tremendously over the next 15 years. Rome III differed from Rome I and II by the use of more evidence-based rather than consensus-based data.

Rome IV

After publication of Rome III in 2006, the Rome Foundation was well recognized as the authoritative body developing diagnostic criteria for research and also for providing education about the FGIDs. Rome IV tried to address the limitations of a symptom-based criteria in several ways: * Some criteria have been simplified and cases not meeting criteria for research can still be identified and treated. * Global education on FGIDs help to understand and characterize the cross-cultural differences in symptom reporting. * Provide translations into other languages * Creation of diagnostic algorithms for a functional GI disorder diagnosis or other diagnosis # To address the severity and variability of clinical presentation, a Multidimensional Clinical Profile (MDCP) system has been created that incorporates the diagnostic criteria with additional clinical, quality of life, psychosocial, and physiological (including biomarker) parameters to more precisely create an individualized treatment plan for the patient. * To help clinicians be better trained in the diagnostic algorithms and the MDCP, the Rome Foundation is developing an interactive, intelligent software platform that will help clinicians make real-time treatment decisions using the diagnostic algorithms and MDCP knowledge base.Drossman DA. The Rome IV Committees, editor. Functional Gastrointestinal Disorders and the Rome IV process. In: Drossman DA, Chang L, Chey WD, Kellow J, Tack J, Whitehead WE, editors. Rome IV functional gastrointestinal disorders: disorders of gut-brain interaction.I. Raleigh, NC: The Rome Foundation; 2016. pp 1–32. In Rome IV, the classification moved from a physiologically based classification to a symptom-based classification. The classifications were based upon organ regions (i.e. esophageal, gastroduodenal, bowel, biliary, anorectal).

Rome IV criteria/classification

The original Rome classification was first published in 1990 and has since been modified with each iteration to develop the subsequent classifications with Rome II, III and IV. Beginning with the original publication in 1990 and leading to Rome I, the classification moved from a physiologically based classification to a symptom-based classification with additional classifications based upon organ regions (i.e. esophageal, gastroduodenal, bowel, biliary, anorectal). The current Rome IV classification is the culmination of the evolution of a series of iterations (Rome I, Rome II,Drossman DA, Corazziari E, Talley NJ, et al., eds. Rome II: the functional gastrointestinal disorders. 2nd ed. McLean (VA): Degnon Associates, 2000. and Rome IIIDrossman DA, Corazziari E, Delvaux M, et al., eds. Rome III: the functional gastrointestinal disorders. 3rd ed. McLean (VA): Degnon Associates, 2006.) with its inception as Rome I. The Rome criteria are a set of criteria used by clinicians to classify a diagnosis of a patient with an FGID (disorder of gut-brain interaction). These Rome criteria are updated every 6–10 years. The current Rome IV classification, published in 2016, is as follows: A. Esophageal Disorders * A1. Functional

chest pain Chest pain is pain or discomfort in the chest, typically the front of the chest. It may be described as sharp, dull, pressure, heaviness or squeezing. Associated symptoms may include pain in the shoulder, arm, upper abdomen, or jaw, along with n ...

* A2.

Functional heartburn Heartburn, also known as pyrosis, cardialgia or acid indigestion, is a burning sensation in the central thorax, chest or epigastrium, upper central abdomen. Heartburn is usually due to regurgitation of gastric acid (gastric reflux) into the eso ...

* A3.

Reflux Reflux is a technique involving the condensation of vapors and the return of this condensate to the system from which it originated. It is used in industrial and laboratory distillations. It is also used in chemistry to supply energy to reactions ...

hypersensitivity * A4.

Globus Globus is Latin for ''sphere'' or ''globe''. It may also refer to: Business * Globus Medical, a medical device company in Audubon, PA * Globus (clothing retailer), an Indian clothing retail store * Globus (company), a Swiss department store chai ...

* A5. Functional

dysphagia Dysphagia is difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, in some contexts it is classified as a disease#Terminology, condition in its own right. It may be a sensation that suggests difficulty in the passag ...

B. Gastroduodenal Disorders * B1.

Functional dyspepsia Indigestion, also known as dyspepsia or upset stomach, is a condition of impaired digestion. Symptoms may include upper abdominal fullness, heartburn, nausea, belching, or upper abdominal pain. People may also experience feeling full earlier t ...

** B1a. Postprandial distress syndrome (PDS) ** B1b. Epigastric pain syndrome (EPS) * B2.

Belching Burping (also called belching and eructation) is the release of gas from the upper digestive tract (esophagus and stomach) of animals through the mouth. It is usually audible. In humans, burping can be caused by normal eating processes, or as ...

disorders ** B2a. Excessive supragastric belching ** B2b. Excessive gastric belching * B3.

Nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the ...

and

vomiting Vomiting (also known as emesis and throwing up) is the involuntary, forceful expulsion of the contents of one's stomach through the mouth and sometimes the Human nose, nose. Vomiting can be the result of ailments like Food-poisoning, foo ...

disorders ** B3a. Chronic nausea vomiting syndrome (CNVS) ** B3b.

Cyclic vomiting syndrome Cyclic vomiting syndrome (CVS) is a chronic functional condition of unknown pathogenesis. CVS is characterized as recurring episodes lasting a single day to multiple weeks. Each episode is divided into four phases: inter-episodic, prodrome, vom ...

(CVS) ** B3c.

Cannabinoid hyperemesis syndrome Cannabinoid hyperemesis syndrome (CHS) is recurrent nausea, vomiting, and cramping abdominal pain that can occur due to prolonged, high-dose cannabis use. These symptoms may be relieved temporarily by taking a hot shower or bath. Complications ...

(CHS) * B4.

Rumination syndrome Rumination syndrome, or merycism, is a chronic motility disorder characterized by effortless regurgitation of most meals following consumption, due to the involuntary contraction of the muscles around the abdomen. There is no retching, nausea, he ...

C. Bowel Disorders * C1.

Irritable bowel syndrome Irritable bowel syndrome (IBS) is a "disorder of gut-brain interaction" characterized by a group of symptoms that commonly include abdominal pain and or abdominal bloating and changes in the consistency of bowel movements. These symptoms may ...

(IBS) ** IBS with predominant constipation (IBS-C) ** IBS with predominant diarrhea (IBS-D) ** IBS with mixed bowel habits (IBS-M) ** IBS unclassified (IBS-U) * C2. Functional

constipation Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement ...

* C3. Functional

diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin wi ...

* C4. Functional abdominal

bloating Abdominal bloating (or simply bloating) is a short-term disease that affects the gastrointestinal tract. Bloating is generally characterized by an excess buildup of gas, air or fluids in the stomach. A person may have feelings of tightness, press ...

/distension * C5. Unspecified functional bowel disorder * C6.

Opioid-induced constipation Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid use ...

D. Centrally Mediated Disorders of Gastrointestinal Pain * D1. Centrally mediated

abdominal pain Abdominal pain, also known as a stomach ache, is a symptom Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than ...

syndrome (CAPS) * D2. Narcotic bowel syndrome (NBS)/ Opioid-induced GI hyperalgesia E. Gallbladder and Sphincter of Oddi disorders * E1. Biliary pain ** E1a. Functional

gallbladder In vertebrates, the gallbladder, also known as the cholecyst, is a small hollow organ where bile is stored and concentrated before it is released into the small intestine. In humans, the pear-shaped gallbladder lies beneath the liver, although ...

disorder ** E1b. Functional biliary

sphincter of Oddi The sphincter of Oddi (also hepatopancreatic sphincter or Glisson's sphincter), abbreviated as SO, is a muscular valve that in some animals, including humans, controls the flow of digestive juices (bile and pancreatic juice) out of the pancreas t ...

disorder * E2. Functional

pancreatic The pancreas is an Organ (anatomy), organ of the digestive system and endocrine system of vertebrates. In humans, it is located in the abdominal cavity, abdomen behind the stomach and functions as a gland. The pancreas is a mixed or heterocrine ...

sphincter of Oddi disorder F. Anorectal Disorders * F1.

Fecal incontinence Fecal incontinence (FI), or in some forms encopresis, is a lack of control over defecation, leading to involuntary loss of bowel contents, both liquid stool elements and mucus, or solid feces. When this loss includes flatus (gas), it is referred ...

* F2. Functional anorectal pain ** F2a.

Levator ani The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis. It is attached to the inner surface of each side of the ...

syndrome ** F2b. Unspecified functional anorectal pain ** F2c.

Proctalgia fugax Proctalgia fugax, a variant of levator ani syndrome, is a severe, episodic pain in the regions of the rectum and anus. It can be caused by cramping of the levator ani muscle, particularly in the pubococcygeal part. Signs and symptoms It most of ...

* F3. Functional defecation disorders ** F3a. Inadequate defecatory propulsion ** F3b.

Dyssynergic defecation Obstructed defecation syndrome (abbreviated as ODS, with many synonymous terms) is a major cause of functional constipation (primary constipation), of which it is considered a subtype. It is characterized by difficult and/or incomplete emptying of ...

G. Childhood Functional GI Disorders: Neonate/Toddler * G1. Infant regurgitation * G2. Rumination syndrome * G3. Cyclic vomiting syndrome (CVS) * G4. Infant colic * G5. Functional diarrhea * G6. Infant dyschezia * G7. Functional constipation H. Childhood Functional GI Disorders: Child/Adolescent * H1. Functional nausea and vomiting disorders ** H1a. Cyclic vomiting syndrome (CVS) ** H1b. Functional nausea and functional vomiting *** H1b1. Functional nausea *** H1b2. Functional vomiting ** H1c. Rumination syndrome ** H1d.

Aerophagia Aerophagia (or aerophagy) is a condition of excessive air swallowing, which goes to the stomach instead of the lungs. Aerophagia may also refer to an unusual condition where the primary symptom is excessive flatus (farting), belching (burping) is ...

* H2. Functional abdominal pain disorders ** H2a. Functional dyspepsia *** H2a1. Postprandial distress syndrome *** H2a2. Epigastric pain syndrome ** H2b. Irritable bowel syndrome (IBS) ** H2c.

Abdominal migraine Abdominal migraine is a variant type of migraine. It primarily affects Child, children, and is rare in Adult, adults. It mainly causes episodes of abdominal pain without an accompanying headache. It is poorly understood. It is difficult to confirm ...

** H2d. Functional abdominal pain ‒ NOS * H3. Functional defecation disorders ** H3a. Functional constipation ** H3b. Nonretentive fecal incontinence

References and sources

* {{cite journal, author=Thompson WG, title=The Road to Rome, journal=Gastroenterology, year=2006, volume=130, issue=5, pages=1552–1556, doi=10.1053/j.gastro.2006.03.011, pmid=16678568, url=http://www.gastrojournal.org/article/S0016-5085(06)00546-4/fulltext

External links

The Rome Foundation
Gastroenterology Diagnostic gastroenterology