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Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features, and Rome IV

  • Douglas A. Drossman
    Correspondence
    Reprint requests Address requests for reprints to: Douglas A. Drossman, MD, 901 Kings Mill Road, Chapel Hill, NC 27517.
    Affiliations
    Center for Education and Practice of Biopsychosocial Care, Drossman Gastroenterology, Chapel Hill, North Carolina
    Center of Functional GI and Motility Disorders, University of North Carolina, Chapel Hill, North Carolina
    Rome Foundation, Chapel Hill, North Carolina
    Search for articles by this author
      Functional gastrointestinal disorders (FGIDs), the most common diagnoses in gastroenterology, are recognized by morphologic and physiological abnormalities that often occur in combination including motility disturbance, visceral hypersensitivity, altered mucosal and immune function, altered gut microbiota, and altered central nervous system processing. Research on these gut–brain interaction disorders is based on using specific diagnostic criteria. The Rome Foundation has played a pivotal role in creating diagnostic criteria, thus operationalizing the dissemination of new knowledge in the field of FGIDs. Rome IV is a compendium of the knowledge accumulated since Rome III was published 10 years ago. It improves upon Rome III by: (1) updating the basic and clinical literature; (2) offering new information on gut microenvironment, gut–brain interactions, pharmacogenomics, biopsychosocial, gender and cross-cultural understandings of FGIDs; (3) reduces the use of imprecise and occasionally stigmatizing terms when possible; (4) uses updated diagnostic algorithms; and (5) incorporates information on the patient illness experience, and physiological subgroups or biomarkers that might lead to more targeted treatment. This introductory article sets the stage for the remaining 17 articles that follow and offers a historical overview of the FGID field, differentiates FGIDs from motility and structural disorders, discusses the changes from Rome III, reviews the Rome committee process, provides a biopsychosocial pathophysiological conceptualization of FGIDs, and offers an approach to patient care.

      Keywords

      Abbreviations used in this paper:

      CNS (central nervous system), FGID (functional gastrointestinal disorder), GI (gastrointestinal), IBS (irritable bowel syndrome), SOD (sphincter of Oddi)
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