Rome IV Diagnostic Criteria for Functional Chest Pain
Rome IV criteria for non-cardiac functional chest pain originating from the oesophagus. Requires cardiac aetiology to be excluded first. Diagnoses functional chest pain of presumed oesophageal origin.
Score interpretation
Insufficient criteria for functional chest pain -- further evaluation required
→ Exclude cardiac (ECG, troponin, stress testing); exclude GERD (PPI trial 4-8 weeks, upper endoscopy if alarm features); exclude oesophageal motility disorder (manometry); consider if musculoskeletal (costochondritis -- Tietze syndrome, localised tenderness).
Rome IV functional chest pain confirmed -- biopsychosocial management approach
→ Reassure: symptoms real but not cardiac or structural; PPI trial 8 weeks (to exclude GERD contribution); tricyclic antidepressant if PPI fails (amitriptyline 10-25 mg nocte -- reduces visceral hypersensitivity; imipramine -- SSRI less effective for this indication); psychological therapy: CBT or hypnotherapy for refractory symptoms; visceral hypersensitivity: low-dose PPI + low-dose TCA combination; pain neuroscience education; avoid excessive cardiac investigations (reassurance more helpful); GI motility specialist referral if refractory.
Interpretation bands for the Rome IV Chest Pain. Apply clinical judgement and local guidance.
References
- Aziz Q et al. Esophageal disorders. Gastroenterology. 2016;150(6):1368-1379.
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 Dyspepsia · Functional GI Disorders
- Rome IV Diagnostic Criteria for Functional Constipation · Functional GI Disorders
- Rome IV Diagnostic Criteria for Globus · Functional GI Disorders
- Rome IV Diagnostic Criteria for Cyclic Vomiting Syndrome (CVS) · Functional GI Disorders
- Lidocaine IV (Cardiac Arrhythmia) · Antiarrhythmic
- Protamine Sulphate (Heparin Reversal) · Heparin Reversal / Cardiac Surgery
- Mavacamten · Cardiac myosin inhibitor
- Methoxyflurane · Inhaled Analgesic — Acute Pain
- Digoxin · Cardiac Glycoside
- Fentanyl Transdermal Patch (Elderly Chronic Pain) · Opioid Analgesic — Transdermal Patch
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.