Ten years after Rome IV, the Rome Foundation published Rome V, updating the international diagnostic criteria for disorders of gut-brain interaction (DGBIs). The new criteria are intended to better reflect patients seen in routine clinical practice. The update also introduces several new diagnostic entities and refines existing criteria without fundamentally changing the management of DGBIs. It also confirms the move away from the term “functional gastrointestinal disorders,” replacing it with terminology that better reflects the current understanding of these conditions.

Diagnostic Criteria

To better reflect the range of clinical presentations, Rome V introduced clinical criteria intended for use in routine practice.

A diagnosis can be made when patients have the following:

• Symptoms consistent with DGBI
• An organic disorder that has been reasonably excluded
• Symptoms that are sufficiently bothersome to prompt consultation or interfere with daily activities

In irritable bowel syndrome (IBS), abdominal discomfort is reintroduced alongside abdominal pain because some patients primarily describe discomfort rather than pain.

The frequency threshold has also been relaxed. Abdominal pain or discomfort must be present at least 3 days per month during the previous 3 months compared with at least 1 d/wk under Rome IV. The previous threshold may have been selected for patients with more severe symptoms than those typically observed in routine practice. The minimum symptom duration can also be reduced to 8 weeks compared with 6 months under Rome IV.

Rome V also includes diagnostic algorithms in a dedicated volume published by the Rome Foundation to facilitate the diagnosis of the main DGBIs.

The symptoms do not have to be continuous. This distinction helps differentiate IBS from abdominal pain syndromes mediated by the central nervous system, in which pain is persistent.

New Entities

Rome V adds several diagnostic entities, including

• Retrograde cricopharyngeus dysfunction, also known as no burp syndrome or “inability to belch syndrome”
• Abdominal migraine in adults, classified as a central nervous system-mediated digestive pain disorder
• Anorectal sensory disorders that distinguish between rectal hypersensitivity and hyposensitivity

Several terms have also been updated by removing the qualifier “functional.” For example, “functional constipation” is now referred to as “chronic constipation.”

Patient-Centered Care

Rome V also outlines a biopsychosocial approach to DGBIs that considers digestive mechanisms, psychosocial factors, and patient experience. Psychological factors are not required for diagnosis but can influence symptom severity. Conversely, chronic digestive disorders can impair quality of life and contribute to psychological distress.

These guidelines emphasize the importance of a strong doctor-patient relationship that recognizes the patient’s experience, involves the patient in setting treatment priorities, and addresses emotional factors.

Treatment should be tailored to symptom severity and its impact on daily life and may include:

• In mild cases: information about the condition, reassurance, and lifestyle and dietary recommendations
• In moderate cases: targeted medication combined with behavioral approaches, such as cognitive-behavioral therapy, hypnosis, or mindfulness
• In more severe cases, central neuromodulators, including tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors, are used together with a coordinated multidisciplinary approach

This story was translated from Univadis France, part of the Medscape Professional Network.