New Rome IV Diagnostic Criteria for Irritable Bowel Syndrome (IBS) Will Include Individualized Clinical Profiles

As this blog reported in the February 23, 2015 post, in December 2014, functional gastrointestinal disorder experts from many countries, including several who are sometimes mentioned on this blog, met in Rome, Italy to complete the latest revision to the Rome criteria. The Rome criteria are the international standard used to diagnose functional gastrointestinal disorders such as irritable bowel syndrome (IBS). Some version of the Rome criteria has been in existence for nearly 25 years. Rome III, the current version, came into use in 2006. Rome IV is now in the usual process of preparation for expected publication in a gastroenterology journal by spring 2016, a decade after Rome III.

Full specific details of the improvements in Rome IV are not available yet. However, according to the Rome Foundation Rome IV Frequently Asked Questions page,  in part, “We also expect to show with Rome IV that we can finally discard the functional-organic dichotomy that tends to stigmatize these disorders. Functional GI disorders are now understood as having abnormalities in mucosal immune dysfunction and the microbiota.” (para. 2)

Also the September 2015 edition of Family Practice News, a digital publication for family practice physicians, published an article entitled “Symptom-based diagnostic criteria: A work in progress in IBS,”  which includes a significant amount of commentary from Douglas Drossman, MD, MACG. Dr. Drossman is founder and president of the Rome Foundation, founder and president of the Drossman Center for the Education and Practice of Biopsychosocial Care, co-founder and retired co-director of the University of North Carolina Center for Functional GI Disorders, along with many other pivotal roles in the development of the field over his 40+ year career.

In this interview, he introduces the newly added Multidimensional Clinical Profile (MDCP), which is incorporates 5 categories aimed at capturing individual aspects of a given patient’s situation that previous versions of the Rome criteria have not. As Dr. Drossman explainsm  Category A encompasses diagnosis, using symptom-based Rome criteria as well as any physiological criteria. Category B involves “clinical modifiers,” such as IBS subtype, any post-infective history, FODMAP sensitivity and others. Category C is the patient’s report of the degree of symptom interference with his or her life. Category D are psychosocial modifiers or comorbid conditions such as a mental health diagnosis, abuse history, if any, (one factor that research has shown is one risk factor for future development of IBS), or other medical conditions or situations that may affect how IBS symptoms present. Category E are physiological factors, such as motility, or biomarkers for IBS to be validated in the future, that may affect a specific person’s IBS. Dr. Drossman expresses the hope that the new MDCP will assist physicians in providing a more precise diagnosis and targeted treatment depending on the particular patient’s individual needs.

A  16 page MDCP Primer  in PDF format containing a fuller explanation of the MDCP and sample case studies of its future use is downloadable from the Rome Foundation website. It has been developed by Dr Drossman and 9 other members of the Rome Foundation who are all leading international authorities on various aspects of functional gastrointestinal and motility disorders like IBS. They are from 7 countries: the United States, Spain, Australia, Mexico, Sweden, the United Kingdom and Belgium. The primer is written for medical professionals, however, may be of interest to people with IBS or families who already have some understanding of medical terminology and the science of IBS.

The Family Practice News article linked above in the third paragraph of this blog post, also notes that the Rome Foundation will also be instituting an online, interactive platform to guide medical professionals through the diagnosis and decision making process and allow them to consult with functional gastrointestinal disorder experts around the world.

All of this news appears promising  and a reason to look forward to the unveiling of Rome IV in the near future. IBS Impact thanks all of the experts involved in Rome IV, who are constantly working to improve diagnosis, treatment, research and functional GI education for those of us who live with these conditions and the professionals who may provide care to us. With better tools and greater awareness, many more of us will experience improved quality of life.

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