Employing a consensus approach, our working team critically considered the available
evidence and multinational expert criticism, revised the Rome II diagnostic criteria
for the functional bowel disorders, and updated diagnosis and treatment recommendations.
Diagnosis of a functional bowel disorder (FBD) requires characteristic symptoms during
the last 3 months and onset > or =6 months ago. Alarm symptoms suggest the possibility
of structural disease, but do not necessarily negate a diagnosis of an FBD. Irritable
bowel syndrome (IBS), functional bloating, functional constipation, and functional
diarrhea are best identified by symptom-based approaches. Subtyping of IBS is controversial,
and we suggest it be based on stool form, which can be aided by use of the Bristol
Stool Form Scale. Diagnostic testing should be guided by the patient's age, primary
symptom characteristics, and other clinical and laboratory features. Treatment of
FBDs is based on an individualized evaluation, explanation, and reassurance. Alterations
in diet, drug treatment aimed at predominant symptoms, and psychotherapy may be beneficial.