Rome IV Diagnostic Criteria for Functional Dyspepsia

Rome IV Functional Dyspepsia

Bothersome Postprandial Fullness

Early Satiation

Epigastric Pain

Epigastric Burning

Symptoms ≥3 months (onset ≥6 months ago)

Criteria Met: 0

Criteria Not Met

No dyspepsia criteria are present. Functional dyspepsia diagnosis not supported by Rome IV criteria.

Official Rome IV criteria for the diagnosis of functional dyspepsia.

Why Use

Helps to make a diagnosis of functional dyspepsia when appropriate workup of upper GI symptoms is nondiagnostic. Helps to distinguish symptoms from other common disorders, such as GERD. Helps to guide management of functional dyspepsia based on subtype (post-prandial distress syndrome vs. epigastric pain syndrome).

When to Use

Patients presenting with recurrent upper GI symptoms suggestive of dyspepsia for at least the past 6 months. The diagnosis of functional dyspepsia should be made by clinical history, physical examination, minimal laboratory tests, and a normal upper endoscopy.

Formula

Step 1. Determine if criteria for functional dyspepsia are met. Must fulfill both the following criteria for the last 3 months with symptom onset ≥6 months ago: ≥1 of the following: Bothersome postprandial fullness. Bothersome early satiation. Bothersome epigastric pain. Bothersome epigastric burning. No evidence of organic, systemic, metabolic or structural disease (including on upper endoscopy) that is likely to explain the symptoms. Step 2. If above criteria are met, then determine subtype: Postprandial Distress Syndrome: Must include one or both of the following at least 3 days per week: Bothersome postprandial fullness. Bothersome early satiation. Epigastric Pain Syndrome: Must include one or both of the following at least 1 day per week: Bothersome epigastric pain. Bothersome epigastric burning. *Note: patients may be positive for both postprandial distress syndrome AND epigastric pain syndrome.

Pearls / Pitfalls

Developed to diagnose functional dyspepsia in patients presenting with bothersome upper GI symptoms. A diagnosis of functional dyspepsia can only be made after a careful diagnostic workup reveals no evidence of organic, systemic, or metabolic disease to explain the symptoms. Workup should include upper endoscopy and evaluation for the presence of Helicobacter pylori infection (and treatment if positive). Patients who meet criteria for functional dyspepsia without an upper endoscopy being performed are considered uninvestigated dyspepsia. Gastroesophageal reflux disease (GERD) may overlap with functional dyspepsia, but GERD and functional dyspepsia are distinct disorders. There are two subtypes of functional dyspepsia each with its own criteria: post-prandial distress syndrome, which is related to meals, and epigastric pain syndrome, which may or may not be related to meals.

Management

Management of functional dyspepsia should be based on the subcategorization. For postprandial distress syndrome (PDS): Mirtazepine. Buspirone. Prokinetic medications. Behavioral therapy. For epigastric pain syndrome (EPS): Treatment of H. pylori. Proton pump inhibitor. Tricyclic antidepressant or other neuromodulators. Behavioral therapy. Consult ACG guidelines for further details.

Critical Actions

This calculator should only be used in patients after appropriate organic, systemic, and metabolic causes have been ruled out after careful investigation, which includes upper endoscopy. Note: other GI conditions, such as GERD and IBS may coexist with functional dyspepsia.

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.