Functional gastrointestinal disorders in 2007 and Rome III: something new, something borrowed, something objective

This review highlights the changes recommended by Rome III to the criteria for the functional gastrointestinal disorders and summarizes the practical implications for clinical practice. The committee retained functional dyspepsia as an umbrella term but emphasized its limited utility; they concluded that those with epigastric pain or burning probably constituted a set of patients very distinct from those who reported meal-related symptoms. Rome III added cyclic vomiting syndrome to the adult functional nausea and vomiting disorder category. The committee simplified clinical subtyping of irritable bowel syndrome. Problems remain with the Rome criteria for functional gallbladder and sphincter of Oddi disorders. Although these patients' pain is probably genuine, the exact characteristics that identify true biliary-type pain remain poorly defined from a scientific perspective. The Rome criteria have been criticized for potentially over-splitting what are truly interdependent conditions. Nevertheless, the Rome criteria remain the best standard we have for guiding diagnosis and helping choose therapy.