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Rome V: minimizing "functional", maximizing precision in gut-brain disorders.

Jose María Remes-Troche1

  • 1Digestive Physiology and Motility Laboratory, Instituto de Investigaciones Médico-Biológicas. Universidad Veracruzana, Mexico.

Revista Espanola De Enfermedades Digestivas
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PubMed
Summary

The Rome V criteria shift focus from "functional" to disorders of gut-brain interaction (DGBI), emphasizing biological mechanisms. This evolution promotes precise diagnosis and reduces stigma for these conditions.

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Area of Science:

  • Gastroenterology and Neurogastroenterology
  • Disorders of Gut-Brain Interaction (DGBI) research
  • Clinical diagnostic criteria evolution

Background:

  • The term "functional" in gut-brain disorders has historically implied psychosomatic origins, leading to stigma and diagnostic ambiguity.
  • Previous diagnostic criteria lacked precision, hindering mechanism-based research and targeted therapies.
  • A need existed to reframe these conditions as distinct pathophysiological entities.

Purpose of the Study:

  • To introduce the Rome V criteria, representing a significant update in the classification and understanding of disorders of gut-brain interaction (DGBI).
  • To move away from the stigmatizing "functional" label towards a more biologically grounded approach.
  • To enhance diagnostic precision across esophageal, gastroduodenal, bowel, and anorectal disorders.

Main Methods:

  • Conceptual and clinical revision of diagnostic criteria for DGBI.
  • Refinement of terminology, moving from "functional" to DGBI.
  • Integration of updated classifications for related disorders (e.g., Lyon Consensus, Chicago Classification).
  • Phenotyping of gastroduodenal disorders and revision of bowel disorder criteria.
  • Operationalization of anorectal disorders with objective testing recommendations.

Main Results:

  • Rome V reframes DGBI as positive diagnoses rooted in altered gut-brain regulation, visceral sensitivity, motility, and more.
  • Increased diagnostic precision in esophageal, gastroduodenal, and bowel disorders, including revised IBS criteria and renaming of functional constipation to chronic constipation.
  • Enhanced operationalization of anorectal disorders, recognizing rectal hypersensitivity/hyposensitivity and dyssynergic defecation.
  • The criteria promote precision, reduce stigma, and support mechanism-based care.

Conclusions:

  • Rome V signifies a major evolution in DGBI, emphasizing biological mechanisms over the term "functional".
  • The updated criteria offer greater diagnostic precision and aim to reduce patient stigma.
  • Future challenges include clinical implementation, patient communication, and mechanism-based research guided by these new criteria.