Skip to main content
Top
Published in: Current Gastroenterology Reports 4/2017

Open Access 01-04-2017 | Large Intestine (B Cash, Section Editor)

Update on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice

Authors: Magnus Simren, Olafur S. Palsson, William E. Whitehead

Published in: Current Gastroenterology Reports | Issue 4/2017

Login to get access

Abstract

Purpose of Review

The purpose of the review was to provide an update of the Rome IV criteria for colorectal disorders with implications for clinical practice.

Recent Findings

The Rome diagnostic criteria are expert consensus criteria for diagnosing functional gastrointestinal disorders (FGIDs). The current version, Rome IV, was released in May of 2016 after Rome III had been in effect for a decade. It is the collective product of committees that included more than 100 leading functional GI experts. For functional bowel and anorectal disorders, the majority of changes relative to Rome III are relatively minor and will have little impact on clinical practice. However, notable changes with potential impact on clinical practice and research include the changes in the diagnostic criteria for IBS, the modified approach for subtyping of IBS, the view on functional bowel disorders as a spectrum of disorders, and the new definition of fecal incontinence.

Summary

New features in the Rome IV diagnostic criteria for functional bowel and anorectal disorders will likely have modest influence on clinical practice, with a few exceptions.
Literature
1.
go back to reference Drossman DA, Hasler WL. Rome IV-functional GI disorders: disorders of gut-brain interaction. Gastroenterology. 2016;150(6):1257–61.CrossRefPubMed Drossman DA, Hasler WL. Rome IV-functional GI disorders: disorders of gut-brain interaction. Gastroenterology. 2016;150(6):1257–61.CrossRefPubMed
2.
go back to reference •• Lacy BE, Mearin F, Chang L, Chey WD, Lembo AJ, Simren M, et al. Bowel disorders. Gastroenterology. 2016;150(6):1393–407. The Rome IV criteria for bowel disorders.CrossRef •• Lacy BE, Mearin F, Chang L, Chey WD, Lembo AJ, Simren M, et al. Bowel disorders. Gastroenterology. 2016;150(6):1393–407. The Rome IV criteria for bowel disorders.CrossRef
3.
go back to reference •• Rao SS, Bharucha AE, Chiarioni G, Felt-Bersma R, Knowles C, Malcolm A, et al. Functional anorectal disorders. Gastroenterology. 2016;150(6):143–1442. The Rome IV criteria for functional anorectal disorders.CrossRef •• Rao SS, Bharucha AE, Chiarioni G, Felt-Bersma R, Knowles C, Malcolm A, et al. Functional anorectal disorders. Gastroenterology. 2016;150(6):143–1442. The Rome IV criteria for functional anorectal disorders.CrossRef
4.
go back to reference Bharucha AE, Wald A, Enck P, Rao S. Functional anorectal disorders. Gastroenterology. 2006;130(5):1510–8.CrossRefPubMed Bharucha AE, Wald A, Enck P, Rao S. Functional anorectal disorders. Gastroenterology. 2006;130(5):1510–8.CrossRefPubMed
5.
go back to reference Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130(5):1480–91.CrossRefPubMed Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130(5):1480–91.CrossRefPubMed
6.
go back to reference Drossman DA, Thompson WG, Talley NJ, Funch-Jensen P, Janssens J, Whitehead WE. Identification of sub-groups of functional gastrointestinal disorders. Gastroenterol Int. 1990;3(4):159–72. Drossman DA, Thompson WG, Talley NJ, Funch-Jensen P, Janssens J, Whitehead WE. Identification of sub-groups of functional gastrointestinal disorders. Gastroenterol Int. 1990;3(4):159–72.
7.
go back to reference •• Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV. Gastroenterology. 2016;150(6):1262–79. Description of the Rome IV process.CrossRef •• Drossman DA. Functional gastrointestinal disorders: history, pathophysiology, clinical features and Rome IV. Gastroenterology. 2016;150(6):1262–79. Description of the Rome IV process.CrossRef
8.
go back to reference •• Palsson OS, Whitehead WE, van Tilburg MA, Chang L, Chey W, Crowell MD, et al. Development and validation of the Rome IV diagnostic questionnaire for adults. Gastroenterology. 2016;150(6):1481–91. Rome IV article containing important information about the Rome normative GI symptom study, and validation of the Rome IV criteria.CrossRef •• Palsson OS, Whitehead WE, van Tilburg MA, Chang L, Chey W, Crowell MD, et al. Development and validation of the Rome IV diagnostic questionnaire for adults. Gastroenterology. 2016;150(6):1481–91. Rome IV article containing important information about the Rome normative GI symptom study, and validation of the Rome IV criteria.CrossRef
9.
go back to reference Bharucha AE, Locke GR, Zinsmeister AR, Seide BM, McKeon K, Schleck CD, et al. Differences between painless and painful constipation among community women. Am J Gastroenterol. 2006;101(3):604–12.CrossRefPubMed Bharucha AE, Locke GR, Zinsmeister AR, Seide BM, McKeon K, Schleck CD, et al. Differences between painless and painful constipation among community women. Am J Gastroenterol. 2006;101(3):604–12.CrossRefPubMed
10.
go back to reference Ford AC, Bercik P, Morgan DG, Bolino C, Pintos-Sanchez MI, Moayyedi P. Validation of the Rome III criteria for the diagnosis of irritable bowel syndrome in secondary care. Gastroenterology. 2013;145(6):1262–70. e1.CrossRefPubMed Ford AC, Bercik P, Morgan DG, Bolino C, Pintos-Sanchez MI, Moayyedi P. Validation of the Rome III criteria for the diagnosis of irritable bowel syndrome in secondary care. Gastroenterology. 2013;145(6):1262–70. e1.CrossRefPubMed
11.
go back to reference Ford AC, Bercik P, Morgan DG, Bolino C, Pintos-Sanchez MI, Moayyedi P. Characteristics of functional bowel disorder patients: a cross-sectional survey using the Rome III criteria. Aliment Pharmacol Ther. 2014;39(3):312–21.CrossRefPubMed Ford AC, Bercik P, Morgan DG, Bolino C, Pintos-Sanchez MI, Moayyedi P. Characteristics of functional bowel disorder patients: a cross-sectional survey using the Rome III criteria. Aliment Pharmacol Ther. 2014;39(3):312–21.CrossRefPubMed
12.
go back to reference •• Palsson OS, Baggish JS, Turner MJ, Whitehead WE. IBS patients show frequent fluctuations between loose/watery and hard/lumpy stools: implications for treatment. Am J Gastroenterol. 2012;107(2):286–95. Study demonstrating fluctuations in consistency and frequency of bowel movements in IBS patients.CrossRefPubMed •• Palsson OS, Baggish JS, Turner MJ, Whitehead WE. IBS patients show frequent fluctuations between loose/watery and hard/lumpy stools: implications for treatment. Am J Gastroenterol. 2012;107(2):286–95. Study demonstrating fluctuations in consistency and frequency of bowel movements in IBS patients.CrossRefPubMed
13.
go back to reference Rey E, Balboa A, Mearin F. Chronic constipation, irritable bowel syndrome with constipation and constipation with pain/discomfort: similarities and differences. Am J Gastroenterol. 2014;109(6):876–84.CrossRefPubMed Rey E, Balboa A, Mearin F. Chronic constipation, irritable bowel syndrome with constipation and constipation with pain/discomfort: similarities and differences. Am J Gastroenterol. 2014;109(6):876–84.CrossRefPubMed
14.
go back to reference Shekhar C, Monaghan PJ, Morris J, Issa B, Whorwell PJ, Keevil B, et al. Rome III functional constipation and irritable bowel syndrome with constipation are similar disorders within a spectrum of sensitization, regulated by serotonin. Gastroenterology. 2013;145(4):749–57. quiz e13-4.CrossRefPubMed Shekhar C, Monaghan PJ, Morris J, Issa B, Whorwell PJ, Keevil B, et al. Rome III functional constipation and irritable bowel syndrome with constipation are similar disorders within a spectrum of sensitization, regulated by serotonin. Gastroenterology. 2013;145(4):749–57. quiz e13-4.CrossRefPubMed
15.
go back to reference •• Wong RK, Palsson OS, Turner MJ, Levy RL, Feld AD, von Korff M, et al. Inability of the Rome III criteria to distinguish functional constipation from constipation-subtype irritable bowel syndrome. Am J Gastroenterol. 2010;105(10):2228–34. Study demonstrating substantial overlap between IBS-C and functional constipation.CrossRefPubMedPubMedCentral •• Wong RK, Palsson OS, Turner MJ, Levy RL, Feld AD, von Korff M, et al. Inability of the Rome III criteria to distinguish functional constipation from constipation-subtype irritable bowel syndrome. Am J Gastroenterol. 2010;105(10):2228–34. Study demonstrating substantial overlap between IBS-C and functional constipation.CrossRefPubMedPubMedCentral
16.
go back to reference Spiegel BM, Bolus R, Agarwal N, Sayuk G, Harris LA, Lucak S, et al. Measuring symptoms in the irritable bowel syndrome: development of a framework for clinical trials. Aliment Pharmacol Ther. 2010;32(10):1275–91.CrossRefPubMed Spiegel BM, Bolus R, Agarwal N, Sayuk G, Harris LA, Lucak S, et al. Measuring symptoms in the irritable bowel syndrome: development of a framework for clinical trials. Aliment Pharmacol Ther. 2010;32(10):1275–91.CrossRefPubMed
17.
go back to reference Palsson OS, Baggish J, Whitehead WE. Episodic nature of symptoms in irritable bowel syndrome. Am J Gastroenterol. 2014;109(9):1450–60.CrossRefPubMed Palsson OS, Baggish J, Whitehead WE. Episodic nature of symptoms in irritable bowel syndrome. Am J Gastroenterol. 2014;109(9):1450–60.CrossRefPubMed
18.
go back to reference Ragnarsson G, Bodemar G. Pain is temporally related to eating but not to defaecation in the irritable bowel syndrome (IBS). Patients’ description of diarrhea, constipation and symptom variation during a prospective 6-week study. Eur J Gastroenterol Hepatol. 1998;10(5):415–21.CrossRefPubMed Ragnarsson G, Bodemar G. Pain is temporally related to eating but not to defaecation in the irritable bowel syndrome (IBS). Patients’ description of diarrhea, constipation and symptom variation during a prospective 6-week study. Eur J Gastroenterol Hepatol. 1998;10(5):415–21.CrossRefPubMed
19.
go back to reference Walter SA, Ragnarsson G, Bodemar G. New criteria for irritable bowel syndrome based on prospective symptom evaluation. Am J Gastroenterol. 2005;100(11):2598–9.CrossRefPubMed Walter SA, Ragnarsson G, Bodemar G. New criteria for irritable bowel syndrome based on prospective symptom evaluation. Am J Gastroenterol. 2005;100(11):2598–9.CrossRefPubMed
20.
go back to reference Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32(9):920–4.CrossRefPubMed Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol. 1997;32(9):920–4.CrossRefPubMed
21.
go back to reference Heaton KW, O’Donnell LJ. An office guide to whole-gut transit time. Patients’ recollection of their stool form. J Clin Gastroenterol. 1994;19(1):28–30.CrossRefPubMed Heaton KW, O’Donnell LJ. An office guide to whole-gut transit time. Patients’ recollection of their stool form. J Clin Gastroenterol. 1994;19(1):28–30.CrossRefPubMed
22.
go back to reference Dorn SD, Morris CB, Hu Y, Toner BB, Diamant N, Whitehead WE, et al. Irritable bowel syndrome subtypes defined by Rome II and Rome III criteria are similar. J Clin Gastroenterol. 2009;43(3):214–20.CrossRefPubMed Dorn SD, Morris CB, Hu Y, Toner BB, Diamant N, Whitehead WE, et al. Irritable bowel syndrome subtypes defined by Rome II and Rome III criteria are similar. J Clin Gastroenterol. 2009;43(3):214–20.CrossRefPubMed
23.
go back to reference Engsbro AL, Simren M, Bytzer P. The Rome II and Rome III criteria identify the same subtype-populations in irritable bowel syndrome: agreement depends on the method used for symptom report. Neurogastroenterol Motil. 2012;24(7):604–11. e266.CrossRefPubMed Engsbro AL, Simren M, Bytzer P. The Rome II and Rome III criteria identify the same subtype-populations in irritable bowel syndrome: agreement depends on the method used for symptom report. Neurogastroenterol Motil. 2012;24(7):604–11. e266.CrossRefPubMed
24.
go back to reference Ersryd A, Posserud I, Abrahamsson H, Simren M. Subtyping the irritable bowel syndrome by predominant bowel habit: Rome II versus Rome III. Aliment Pharmacol Ther. 2007;26(6):953–61.CrossRefPubMed Ersryd A, Posserud I, Abrahamsson H, Simren M. Subtyping the irritable bowel syndrome by predominant bowel habit: Rome II versus Rome III. Aliment Pharmacol Ther. 2007;26(6):953–61.CrossRefPubMed
25.
go back to reference Simren M, Palsson OS, Heymen S, Bajor A, Tornblom H, Whitehead WE. Fecal incontinence in irritable bowel syndrome: Prevalence and associated factors in Swedish and American patients. Neurogastroenterol Motil. 2016;29(2):e12919. Simren M, Palsson OS, Heymen S, Bajor A, Tornblom H, Whitehead WE. Fecal incontinence in irritable bowel syndrome: Prevalence and associated factors in Swedish and American patients. Neurogastroenterol Motil. 2016;29(2):e12919.
26.
go back to reference Engsbro AL, Simren M, Bytzer P. Short-term stability of subtypes in the irritable bowel syndrome: prospective evaluation using the Rome III classification. Aliment Pharmacol Ther. 2012;35(3):350–9.CrossRefPubMed Engsbro AL, Simren M, Bytzer P. Short-term stability of subtypes in the irritable bowel syndrome: prospective evaluation using the Rome III classification. Aliment Pharmacol Ther. 2012;35(3):350–9.CrossRefPubMed
27.
go back to reference Bell TJ, Panchal SJ, Miaskowski C, Bolge SC, Milanova T, Williamson R. The prevalence, severity, and impact of opioid-induced bowel dysfunction: results of a US and European Patient Survey (PROBE 1). Pain Med. 2009;10(1):35–42.CrossRefPubMed Bell TJ, Panchal SJ, Miaskowski C, Bolge SC, Milanova T, Williamson R. The prevalence, severity, and impact of opioid-induced bowel dysfunction: results of a US and European Patient Survey (PROBE 1). Pain Med. 2009;10(1):35–42.CrossRefPubMed
28.
go back to reference Holzer P, Ahmedzai SH, Niederle N, Leyendecker P, Hopp M, Bosse B, et al. Opioid-induced bowel dysfunction in cancer-related pain: causes, consequences, and a novel approach for its management. J Opioid Manag. 2009;5(3):145–51.PubMed Holzer P, Ahmedzai SH, Niederle N, Leyendecker P, Hopp M, Bosse B, et al. Opioid-induced bowel dysfunction in cancer-related pain: causes, consequences, and a novel approach for its management. J Opioid Manag. 2009;5(3):145–51.PubMed
29.
go back to reference Holder RM, Rhee D. Novel oral therapies for opioid-induced bowel dysfunction in patients with chronic noncancer pain. Pharmacotherapy. 2016;36(3):287–99.CrossRefPubMed Holder RM, Rhee D. Novel oral therapies for opioid-induced bowel dysfunction in patients with chronic noncancer pain. Pharmacotherapy. 2016;36(3):287–99.CrossRefPubMed
30.
go back to reference •• Keefer L, Drossman DA, Guthrie E, Simren M, Tillisch K, Olden K, et al. Centrally Mediated Disorders of Gastrointestinal Pain. Gastroenterology. 2016;150(6):1408–19. The Rome IV criteria for Centrally Mediated Disorders of Gastrointestinal Pain. •• Keefer L, Drossman DA, Guthrie E, Simren M, Tillisch K, Olden K, et al. Centrally Mediated Disorders of Gastrointestinal Pain. Gastroenterology. 2016;150(6):1408–19. The Rome IV criteria for Centrally Mediated Disorders of Gastrointestinal Pain.
31.
go back to reference Ducoffe AR, York A, Hu DJ, Perfetto D, Kerns RD. National action plan for adverse drug event prevention: recommendations for safer outpatient opioid use. Pain Med. 2016;17(12):2291–304.CrossRefPubMed Ducoffe AR, York A, Hu DJ, Perfetto D, Kerns RD. National action plan for adverse drug event prevention: recommendations for safer outpatient opioid use. Pain Med. 2016;17(12):2291–304.CrossRefPubMed
32.
go back to reference Whitehead WE, Bassotti G, Palsson O, Taub E, Cook III EC, Drossman DA. Factor analysis of bowel symptoms in US and Italian populations. DigLiver Dis. 2003;35(11):774–83. Whitehead WE, Bassotti G, Palsson O, Taub E, Cook III EC, Drossman DA. Factor analysis of bowel symptoms in US and Italian populations. DigLiver Dis. 2003;35(11):774–83.
33.
go back to reference •• Chiarioni G, Nardo A, Vantini I, Romito A, Whitehead WE. Biofeedback is superior to electrogalvanic stimulation and massage for treatment of levator ani syndrome. Gastroenterology. 2010;138(4):1321–9. Important treatment study for patients with rectal pain.CrossRefPubMedPubMedCentral •• Chiarioni G, Nardo A, Vantini I, Romito A, Whitehead WE. Biofeedback is superior to electrogalvanic stimulation and massage for treatment of levator ani syndrome. Gastroenterology. 2010;138(4):1321–9. Important treatment study for patients with rectal pain.CrossRefPubMedPubMedCentral
34.
go back to reference Siah KT, Wong RK, Whitehead WE. Chronic constipation and constipation-predominant IBS: separate and distinct disorders or a spectrum of disease? Gastroenterol Hepatol (N Y). 2016;12(3):171–8. Siah KT, Wong RK, Whitehead WE. Chronic constipation and constipation-predominant IBS: separate and distinct disorders or a spectrum of disease? Gastroenterol Hepatol (N Y). 2016;12(3):171–8.
35.
go back to reference Whitehead WE, Palsson OS, Simren M. Biomarkers to distinguish functional constipation from irritable bowel syndrome with constipation. Neurogastroenterol Motil. 2016;28(6):783–92.CrossRefPubMed Whitehead WE, Palsson OS, Simren M. Biomarkers to distinguish functional constipation from irritable bowel syndrome with constipation. Neurogastroenterol Motil. 2016;28(6):783–92.CrossRefPubMed
36.
go back to reference Bharucha AE, Rao SS. An update on anorectal disorders for gastroenterologists. Gastroenterology. 2014;146(1):37–45. e2.CrossRefPubMed Bharucha AE, Rao SS. An update on anorectal disorders for gastroenterologists. Gastroenterology. 2014;146(1):37–45. e2.CrossRefPubMed
37.
go back to reference •• Grossi U, Carrington EV, Bharucha AE, Horrocks EJ, Scott SM, Knowles CH. Diagnostic accuracy study of anorectal manometry for diagnosis of dyssynergic defecation. Gut. 2016;65(3):447–55. Study that calls into question the whole concept of dyssynergic defecation and the criteria that have been used to make this diagnosis.CrossRefPubMed •• Grossi U, Carrington EV, Bharucha AE, Horrocks EJ, Scott SM, Knowles CH. Diagnostic accuracy study of anorectal manometry for diagnosis of dyssynergic defecation. Gut. 2016;65(3):447–55. Study that calls into question the whole concept of dyssynergic defecation and the criteria that have been used to make this diagnosis.CrossRefPubMed
38.
go back to reference Noelting J, Ratuapli SK, Bharucha AE, Harvey DM, Ravi K, Zinsmeister AR. Normal values for high-resolution anorectal manometry in healthy women: effects of age and significance of rectoanal gradient. Am J Gastroenterol. 2012;107(10):1530–6.CrossRefPubMedPubMedCentral Noelting J, Ratuapli SK, Bharucha AE, Harvey DM, Ravi K, Zinsmeister AR. Normal values for high-resolution anorectal manometry in healthy women: effects of age and significance of rectoanal gradient. Am J Gastroenterol. 2012;107(10):1530–6.CrossRefPubMedPubMedCentral
39.
go back to reference Chiarioni G, Whitehead WE, Pezza V, Morelli A, Bassotti G. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology. 2006;130(3):657–64.CrossRefPubMed Chiarioni G, Whitehead WE, Pezza V, Morelli A, Bassotti G. Biofeedback is superior to laxatives for normal transit constipation due to pelvic floor dyssynergia. Gastroenterology. 2006;130(3):657–64.CrossRefPubMed
40.
go back to reference Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman D, Whitehead WE. Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia-type constipation. DisColon Rectum. 2007;50(4):428–41.CrossRef Heymen S, Scarlett Y, Jones K, Ringel Y, Drossman D, Whitehead WE. Randomized, controlled trial shows biofeedback to be superior to alternative treatments for patients with pelvic floor dyssynergia-type constipation. DisColon Rectum. 2007;50(4):428–41.CrossRef
41.
go back to reference Rao SS, Seaton K, Miller M, Brown K, Nygaard I, Stumbo P, et al. Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. ClinGastroenterol Hepatol. 2007;5(3):331–8. Rao SS, Seaton K, Miller M, Brown K, Nygaard I, Stumbo P, et al. Randomized controlled trial of biofeedback, sham feedback, and standard therapy for dyssynergic defecation. ClinGastroenterol Hepatol. 2007;5(3):331–8.
Metadata
Title
Update on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice
Authors
Magnus Simren
Olafur S. Palsson
William E. Whitehead
Publication date
01-04-2017
Publisher
Springer US
Published in
Current Gastroenterology Reports / Issue 4/2017
Print ISSN: 1522-8037
Electronic ISSN: 1534-312X
DOI
https://doi.org/10.1007/s11894-017-0554-0
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.