Rome Criteria Requirements for Functional Gastrointestinal Disorders
To meet Rome criteria for a functional gastrointestinal disorder, your patient with abdominal pain must have recurrent abdominal pain at least 1 day per week in the last 3 months, with symptom onset at least 6 months before diagnosis, associated with two or more of the following: pain related to defecation, change in stool frequency, or change in stool form. 1
Core Temporal Requirements
The Rome criteria have evolved but consistently require specific time thresholds that distinguish functional disorders from transient conditions:
- Symptom onset must be at least 6 months prior to diagnosis 2, 1
- Symptoms must be active within the past 3 months 2, 1
- For IBS specifically: abdominal pain must occur at least 1 day per week during the last 3 months 1, 3
These temporal criteria were designed to exclude transient conditions like infections and to identify progressive diseases like bowel cancer, which are typically diagnosed within 6 months of symptom onset 2
Specific Criteria by Disorder Type
For Irritable Bowel Syndrome (IBS)
The patient must have recurrent abdominal pain (not just discomfort—this was eliminated in Rome IV) occurring at least 1 day per week in the last 3 months, plus two or more of: 1, 3
- Pain related to defecation (can improve OR worsen with bowel movements) 1, 3
- Change in frequency of stool 1
- Change in form (appearance) of stool 2, 1
Critical caveat: Rome IV eliminated "discomfort" as a qualifying symptom because it is non-specific and has different meanings across languages—only pain qualifies 3. This makes Rome IV more restrictive than Rome III, with up to 50% of patients who met Rome III criteria no longer meeting Rome IV criteria 1.
For Functional Dyspepsia (FD)
The patient must have one or more bothersome symptoms (severe enough to impact usual activities): 2, 4
- Bothersome epigastric pain 2, 4
- Bothersome epigastric burning 2, 4
- Bothersome postprandial fullness 2, 4
- Bothersome early satiation 2, 4
Plus the same temporal requirements: symptom onset at least 6 months prior to diagnosis, symptoms active within the past 3 months 2, 4
FD has two subtypes with different frequency requirements: 2, 4
- Epigastric Pain Syndrome (EPS): symptoms at least 1 day per week 2, 4
- Postprandial Distress Syndrome (PDS): symptoms at least 3 days per week 2, 4
For Functional Abdominal Pain Syndrome (FAPS)
The patient must have: 5
- Constant or nearly constant abdominal pain 5
- Present for at least 6 months 5
- Loss of daily functioning 5
- Pain with poor relation to gut function (differentiates from IBS) 5
- Pain not associated with changes in bowel habit, eating, or other gut-related events 5
Essential Exclusion Criterion
No evidence of structural or biochemical disease likely to explain the symptoms 2, 4, 6
This requires ruling out organic pathology through appropriate investigation, but the Rome criteria emphasize making a positive diagnosis based on symptom patterns rather than diagnosis by exclusion alone 2, 1
Clinical Application Considerations
Important pitfall: The Rome Foundation acknowledges that the restrictive 6-month symptom duration requirement limits applicability in routine clinical practice and could delay diagnosis and treatment 2. They have developed less restrictive "clinical criteria" requiring only 8 weeks of symptoms for practical clinical use, though all other requirements remain unchanged 2.
Red flags that warrant investigation before applying Rome criteria: 2, 1
- Weight loss 2, 1
- Rectal bleeding 2, 1
- Nocturnal symptoms 2, 1
- Anemia 2, 1
- Age >45 years at symptom onset 2
- Family history of colon cancer 2
Supportive features that increase diagnostic confidence: 2, 1
- Female sex 2, 1
- Age <45 years with symptom duration >2 years 2, 1
- Frequent healthcare visits for non-gastrointestinal complaints 2, 1
Once a functional diagnosis is established using Rome criteria, the incidence of new non-functional diagnoses is extremely low 2, 1, supporting the validity of this symptom-based approach.