Characterization of childhood and adolescent functional gastrointestinal disorders
(FGIDs) has evolved during the two decade long Rome process now culminating in Rome
IV. The era of diagnosing a FGID only when organic disease has been excluded is waning,as
we now have evidence to support symptom-based diagnosis. In child/adolescent Rome
IV we extend this concept by removing the dictum that there was "no evidence for organic
disease" in all definitions and replacing it with "after appropriate medical evaluation
the symptoms cannot be attributed to another medical condition". This change allows
the clinician to perform selective or no testing to support a positive diagnosis of
a FGID. We also point out that FGIDs can coexist with other medical conditions that
themselves result in gastrointestinal symptoms (e.g., inflammatory bowel disease).
In Rome IV functional nausea and functional vomiting are now described. Rome III "abdominal
pain related functional gastrointestinal disorders" (AP-FGID) has been changed to
functional abdominal pain disorders (FAPD) and we have derived a new term, "functional
abdominal pain -not otherwise specified", to describe children who do not fit a specific
disorder such as irritable bowel, functional dyspepsia, or abdominal migraine. Rome
IV FGID definitions should enhance clarity for both clinicians and researchers.