Rome IV Diagnostic Criteria for Functional Abdominal Bloating/Distension

Rome IV Functional Bloating/Distension

Recurrent bloating and/or distension ≥1 day/week

Bloating/distension predominates over other symptoms

Insufficient criteria for IBS

Insufficient criteria for functional constipation

Insufficient criteria for functional diarrhea

Insufficient criteria for postprandial distress syndrome

Present for last 3 months with onset ≥6 months prior

Rome IV Assessment: Negative

Criteria Not Met

No criteria met for Rome IV functional bloating/distension.

Official Rome IV criteria for the diagnosis of functional abdominal bloating or distension.

Why Use

Used to diagnose functional abdominal bloating/distension in the absence of secondary causes of abdominal bloating/distension and another disorder of gut-brain interaction. Making a diagnosis will help guide the need for further work-up and management.

When to Use

Use in patients with symptoms of abdominal bloating and/or distension for at least the last 6 months where there is not a clear systemic cause for their symptoms. In addition they do not fulfill criteria for another disorder of gut-brain interaction (also known as functional GI disorder) such as irritable bowel syndrome (IBS), functional constipation, functional diarrhea or functional dyspepsia. The diagnosis of functional abdominal bloating/distension should be made by clinical history, physical examination, and minimal laboratory tests.

Formula

To fulfill the Rome IV criteria for functional abdominal bloating/distension, patient must have the following (for 3 months prior with symptom onset ≥6 months ago): Recurrent bloating and/or distension occurring, on average, ≥1 day per week. Abdominal bloating and/or distension predominates over other symptoms (mild pain related to bloating may be present as well as minor bowel movement abnormalities). There are insufficient criteria for a diagnosis of irritable bowel syndrome , functional constipation , functional diarrhea , or postprandial distress syndrome.

Pearls / Pitfalls

Bloating is defined as the subjective sensation of abdominal fullness, abdominal pressure or the sensation of trapped gas. Distension is defined as the objective or measurable increase in abdominal girth. Consider the diagnosis of abdominophrenic dyssynergia in patients with visible abdominal distension after meals. Patients may have abdominal bloating, distension or both to meet the diagnosis of functional abdominal bloating and distension. A typical description for abdominal bloating and distension is that it worsens as the day progresses and after ingestion of a meal. Symptoms often are alleviated overnight. Bloating and distension are commonly reported symptoms in other disorders of gut-brain interaction and these should be ruled out. Examples include IBS , functional constipation , functional diarrhea , and functional dyspepsia . Altered bowel habits and abdominal pain may be present to a minor degree but are not used to diagnose functional abdominal bloating/distension. For women, the abdominal bloating and distension should not exclusively occur during their menstrual period. In women, with new onset abdominal bloating/distension, consideration of a pelvic exam and/or ultrasound should be considered.

Management

Studies of therapies in functional abdominal bloating/distension are limited. Many of the treatments that can be trialed have been studied in other disorders of gut brain interactions. Treatments may include: Dietary modifications. Simethicone. Peppermint oil. Neuromodulators (e.g. tricyclic antidepressants). Probiotics. Antibiotics (e.g. rifaximin). Abdominal (diaphragmatic) breathing exercises to treat abdominophrenic dyssynergia. The choice of therapy is outside the scope of this calculator and will depend on clinical context.

Critical Actions

This calculator should only be used in patients who do not have signs or symptoms suggestive of a structural/mechanical, metabolic or systemic cause of their symptoms based on clinical history, physical exam and initial work-up.

Advice

If diagnosis not met (negative): Current symptoms are unlikely to be caused by functional abdominal bloating/distension. Consider further assessment as clinically indicated. Also, see pearls and pitfalls above. If meets diagnosis (positive): Likely diagnosis of functional abdominal bloating and distension. Consider initiating treatment.