Rome IV Diagnostic Criteria for Functional Dyspepsia
Rome IV criteria for functional dyspepsia (FD), the most common functional upper GI disorder. Encompasses two syndromes: Postprandial Distress Syndrome (PDS) and Epigastric Pain Syndrome (EPS). Bothersome meal-induced symptoms and/or epigastric pain/burning for at least 3 months with symptom onset at least 6 months before diagnosis. Must exclude organic disease (endoscopy, Helicobacter pylori testing). Affects 10-20% of adults in Western populations.
Score interpretation
Rome IV FD criteria not met -- a symptom, the duration criterion or exclusion of structural disease is missing
→ If organic disease not yet excluded: upper GI endoscopy (in all patients above 55 with new dyspepsia, or any age with alarm features: weight loss, dysphagia, vomiting, anaemia, palpable mass, family history gastric/oesophageal cancer); H. pylori testing (urea breath test or stool antigen -- most sensitive non-invasive tests) and eradication if positive (clarithromycin triple therapy or bismuth quadruple if clarithromycin resistance suspected); once organic excluded re-assess Rome IV criteria; if symptoms less than 3 months: continue monitoring and reassess.
Rome IV FD criteria met: postprandial fullness and/or early satiation predominant
→ Confirm organic disease excluded (endoscopy, H. pylori, consider USS liver/biliary if biliary symptoms); first-line: PPI (adults: omeprazole 20 mg OD or lansoprazole 30 mg OD) for 4-8 weeks if not already tried; H. pylori eradication if positive (improves symptoms in 10-15% beyond PPI alone); if PDS predominant (postprandial fullness/early satiety): prokinetic agents (adults: metoclopramide 10 mg TDS short term, domperidone if available); if EPS predominant (epigastric pain/burning): PPI or H2 blocker (adults: famotidine 20 mg BD); tricyclic antidepressant (adults: amitriptyline 10-25 mg nocte) for refractory symptoms especially with visceral hypersensitivity; psychological support (CBT, gut-directed hypnotherapy); dietary advice: smaller, more frequent meals; avoid NSAIDs, alcohol, and fatty foods; reassure patient that FD is a real condition -- not imagined; gastroenterology referral if refractory. Children: use a children's formulary.
Rome IV FD criteria met: epigastric pain and/or burning
→ Confirm organic disease excluded (endoscopy, H. pylori, consider USS liver/biliary if biliary symptoms); first-line: PPI (adults: omeprazole 20 mg OD or lansoprazole 30 mg OD) for 4-8 weeks if not already tried; H. pylori eradication if positive (improves symptoms in 10-15% beyond PPI alone); if PDS predominant (postprandial fullness/early satiety): prokinetic agents (adults: metoclopramide 10 mg TDS short term, domperidone if available); if EPS predominant (epigastric pain/burning): PPI or H2 blocker (adults: famotidine 20 mg BD); tricyclic antidepressant (adults: amitriptyline 10-25 mg nocte) for refractory symptoms especially with visceral hypersensitivity; psychological support (CBT, gut-directed hypnotherapy); dietary advice: smaller, more frequent meals; avoid NSAIDs, alcohol, and fatty foods; reassure patient that FD is a real condition -- not imagined; gastroenterology referral if refractory. Children: use a children's formulary.
Rome IV FD criteria met with features of both PDS and EPS
→ Confirm organic disease excluded (endoscopy, H. pylori, consider USS liver/biliary if biliary symptoms); first-line: PPI (adults: omeprazole 20 mg OD or lansoprazole 30 mg OD) for 4-8 weeks if not already tried; H. pylori eradication if positive (improves symptoms in 10-15% beyond PPI alone); if PDS predominant (postprandial fullness/early satiety): prokinetic agents (adults: metoclopramide 10 mg TDS short term, domperidone if available); if EPS predominant (epigastric pain/burning): PPI or H2 blocker (adults: famotidine 20 mg BD); tricyclic antidepressant (adults: amitriptyline 10-25 mg nocte) for refractory symptoms especially with visceral hypersensitivity; psychological support (CBT, gut-directed hypnotherapy); dietary advice: smaller, more frequent meals; avoid NSAIDs, alcohol, and fatty foods; reassure patient that FD is a real condition -- not imagined; gastroenterology referral if refractory. Children: use a children's formulary.
Interpretation bands for the Rome IV Functional Dyspepsia. Apply clinical judgement and local guidance.
References
- Stanghellini V et al. Gastroduodenal Disorders. Gastroenterology. 2016;150(6):1380-1392. (Rome IV criteria)
- NICE CG184. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. NICE. 2014 (updated 2019).
Related
Curated clinical cross-links plus same-class fallbacks.
- Manning Criteria for Irritable Bowel Syndrome · Functional GI Disorders
- Kruis Score for Diagnosis of Irritable Bowel Syndrome · Functional GI Disorders
- Rome IV Diagnostic Criteria for Functional Constipation · Functional GI Disorders
- Rome IV Diagnostic Criteria for Functional Chest Pain · Functional GI Disorders
- Rome IV Diagnostic Criteria for Globus · Functional GI Disorders
- Rome IV Diagnostic Criteria for Cyclic Vomiting Syndrome (CVS) · Functional GI Disorders
- Methoxyflurane · Inhaled Analgesic — Acute Pain
- Borneol with camphene, cineole, menthol, menthone and pinene · Terpene mixture (gallstone dissolution / dyspepsia)
- Fentanyl Transdermal Patch (Elderly Chronic Pain) · Opioid Analgesic — Transdermal Patch
- Morphine Slow-Release (Elderly Chronic Pain) · Opioid Analgesic — Modified-Release Oral
- Bismuth subcitrate potassium with metronidazole and tetracycline hydrochloride · Quadruple therapy for H. pylori (with PPI)
- Amitriptyline (Neuropathic Pain / Migraine) · Tricyclic Antidepressant / Neuropathic Pain Agent
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.
