Five Categories of Lower Gastrointestinal Functional Bowel Disorders in Revised Rome IV Criteria

MAY 23, 2016
Katherine Hasal
“Research in the basic and clinical sciences during the past decade has produced new information on the epidemiology, etiology, pathophysiology, diagnosis, and treatment of functional bowel disorders,” said Fermin Mearin, MD, PhD, of Hospital Quiron in Barcelona, Spain, at a presentation at Digestive Disease Week 2016, a joint meeting of the American Academy for the Study of Liver Diseases (AASLD), American Gastroenterological Association (AGA), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society for Surgery of the Alimentary Tract (SSAT).
The new Rome IV criteria classify the functional bowel disorders into five distinct categories, including irritable bowel syndrome (IBS), functional constipation, functional diarrhea, functional abdominal bloating/distention, and unspecified functional bowel disorder. A new category for opioid-induced constipation, which is distinct from the functional bowel disorders, has been added.
“The main change is conceptual in that these disorders are not independent entities. There is huge overlap, with data increasingly showing that functional disorders are part of a larger spectrum,” said Mearin. “In fact, often times, it can be impossible, for example, to distinguish between IBS with constipation (IBS-C) and functional constipation or IBS with diarrhea (IBS-D) and functional diarrhea.” The data show that, over time, patients often transition quite frequently between one functional bowel disorder to another or from one predominant symptom to another.
With regard to IBS, the word “discomfort” has been eliminated from the definition of IBS. The definition of IBS has been updated to read: “recurrent abdominal pain, on average, at least 1 day per week in the last 3 months, associated with 2 or more of the following criteria: related to defecation, associated with a change in frequency of stool, and associated with a change in form (appearance) of stool.”
“The change in the definition of IBS to exclude the term ‘discomfort’ from the current definition and diagnostic criteria is important because the word doesn’t exist in all languages and is confusing and nonspecific,” Mearin explained.

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