Rome IV Criteria Get Specific about Functional Gastroduodenal Disorders

MAY 23, 2016
Katherine Hasal

Second, he provided an overview of belching disorders, which are defined as audible escapes of air from the esophagus or the stomach into the pharynx. While belching is a common occurrence, for some patients, it can become excessive and troublesome.  In the previous Rome III criteria, the term “aerophagia” (air swallowing) was used, but this term has been dropped in the new criteria because studies have shown that different mechanisms of excessive belching occur. Now, belching disorders are subcategorized as either gastric or supragastric belching, on the basis of the origin of the refluxed gas, as detected by intraluminal impedance measurement.
Next, he discussed the nausea and vomiting disorders. “The term functional vomiting has been dumped,” he said. “The term is pejorative, and no one uses it.” Previously, separate nausea and vomiting sections were provided. In the new criteria, the separate sections have been merged into a single entity called CNVS, for chronic nausea and vomiting syndrome. He noted that chronic nausea can present without vomiting, and vomiting in the absence of nausea might be indicative of organic central nervous system disease, and finally, that nausea may be related or unrelated to meals.
A few minor changes were made to the criteria for cyclic vomiting syndrome (CVS) to reflect the observation that some patients report inter-episodic symptoms other than vomiting. The term CHS, or cannabinoid hyperemesis syndrome, has been added because this disorder is distinct from CVS and exhibits different epidemiology and has specific bathing behavior and therapy.
Finally, he covered rumination syndrome, which is characterized by the repetitive, effortless regurgitation of recently ingested food into the mouth followed by re-chewing and re-swallowing or expulsion of the food bolus. Although the criteria for rumination were essentially unchanged, the new criteria emphasize effortless regurgitation as a major diagnostic key and caution against misdiagnosis as GERD.
“Overall, specific frequency criteria have been added, the symptoms must be bothersome, clearer symptom definitions are required, and an emphasis has been placed on PDS and EPS,” he concluded.

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