The functional gastrointestinal disorders (FGIDs) are the most common disorders seen in Gastroenterology clinical practice. The Rome process has generated consensus definitions of FGIDS, allowing to subdivide patients into diagnostic categories based on the symptom pattern. The Rome IV consensus, presented in 2016, is the most recent update of this diagnostic scheme. This article summarizes the main changes, which include the use of epidemiology-based symptom thresholds to define FGIDs, characterization of FGIDS as disorders of Gut-Brain interaction, and updates of criteria for esophageal disorders, irritable bowel syndrome and Biliary and Sphincter of Oddi disorders based on scientific and technical progress made over the last decade. The Rome IV consensus provides a standard for clinical and research approach to FGIDS for the coming years.
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Functional dyspepsia (FD) is a gut-brain axis disorder characterized by postprandial fullness, early satiety, bloating and/or epigastric pain, which are presumed to originate in the gastroduodenal tract. While the international recommendations in the Rome IV consensus require endoscopy to rule out an organic condition before establishing a diagnosis of FD, international guidelines recommend that, in the absence of risk factors, patient management be initiated at the primary care level by establishing Helicobacter pylori infection status, with eradication when positive, followed by empiric therapy with proton pump inhibitors and/or prokinetics, and that endoscopy be reserved for patients refractory to said measures. Second-line therapy includes neuromodulating agents, among which tricyclic antidepressants and atypical antipsychotics such as levosulpiride stand out.
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