J Neurogastroenterol Motil  
What is new in Rome IV
Max J Schmulson1*, Douglas Arnold Drossman2, 3
1Laboratorio de Hígado, Páncreas y Motilidad (HIPAM), Unidad de Investigación en Medicina Experimental, Facultad de Medicina-Universidad Nacional Autónoma de México (UNAM). Hospital General de México, Dr. Eduardo Liceaga, Mexico City-Mexico. , 2Center for Functional GI and Motility Disorders at University of North Carolina., 3Center for Education and Practice of Biopsychosocial Care and Drossman Gastroenterology, Chapel Hill, NC, USA
Correspondence to: Max J Schmulson , MD
Laboratorio de Hígado, Páncreas y Motilidad (HIPAM) , Unidad de Investigación en Medicina Experimental , Facultad de Medicina , Universidad Nacional Autónoma de México (UNAM) , Hospital General de México, Dr. Eduardo Liceaga , Dr. Balmis #148 , Col. Doctores C.P. 06726 , México D.F. México Tel: +52-5556232673 , Fax: +52-5556232669 ,
E-mail: maxjulio@prodigy.net.mx
Received: December 13, 2016; Accepted: January 2, 2017; Published online: March 9, 2017.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

cc This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Functional gastrointestinal disorders (FGIDs) are diagnosed and classified using the Rome criteria; the criteria may change over time as new scientific data emerge. The Rome IV was released in May 2016. The aim is to review the main changes in Rome IV. FGIDs are now called disorders of gut-brain interaction (DGBI). Rome IV has a multicultural rather than a Western-culture focus. There are new chapters including multicultural, age-gender-women's health, intestinal microenvironment, biopsychosocial, and centrally mediated disorders. New disorders have been included although not truly FGIDs, but fit the new definition of DGBI including opioid-induced gastrointestinal hyperalgesia, opioid-induced constipation, and cannabinoid hyperemesis. Also, new FGIDs based on available evidence including reflux hypersensitivity and centrally mediated abdominal pain syndrome. Using a normative survey to determine the frequency of normal bowel symptoms in the general population changes in the time frame for diagnosis were introduced. For irritable bowel syndrome (IBS) only pain is required and discomfort was eliminated because it is non-specific, having different meanings in different languages. Pain is now related to bowel movements rather than just improving with bowel movements (ie, can get worse with bowel movement). Functional bowel disorders (functional diarrhea, functional constipation, IBS with predominant diarrhea [IBS-D], IBS with predominant constipation [IBS-D], and mixed IBS) are considered to be on a continuum rather than as independent entities. Clinical applications such as diagnostic algorithms and the Multidimensional Clinical Profile have been updated. The new Rome IV iteration is evidence-based, multicultural oriented and with clinical applications. As new evidence become available, future updates are expected.
Keywords: Constipation, Diarrhea, Functional gastrointestinal disorders, Irritable bowel syndrome, Rome IV


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