Roma III Ap B

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Append|x 8
Comparison Table of
Rome II & Rome III
Adult Diagnostic
Criteria
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A. lunct|ono| Lsophogeo| u|sorders A. lunct|ono| Lsophogeo| u|sorders
A1. FunctionaI Heartburn
u|ognost|c cr|ter|o*
Must |nc|ude ull oj the jo||ow|ng:
I. Burning retrosternal discomfort or pain
:. Absence of evidence that gastroesophageal
acid refux is the cause of the symptom
,. Absence of histopathology-based
esophageal motility disorders
Criteria fulflled for the last , months with
symptom onset at least o months prior to
diagnosis
A4. FunctionaI Heartburn
At |eost 12 weeks, wh|ch need not 5e consecut|ve,
|n the preced|ng 12 months oj:
I. Burning retrosternal discomfort or pain;
and
:. Absence of pathologic gastroesophageal
refux, achalasia, or other motility disorder
with a recognized pathologic basis.
A2. FunctionaI Chest Pain of
Presuned EsophageaI Origin
I. Midline chest pain or discomfort that is not
of burning quality
refux is the cause of the symptom
diagnosis
A3. FunctionaI Chest Pain of
Presuned EsophageaI Origin
w|th|n the preced|ng 12 months oj:
I. Midline chest pain or discomfort that is not
of burning quality; and
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A3. FunctionaI Dysphagia
I. Sense of solid and/or liquid foods sticking,
lodging, or passing abnormally through the
esophagus
diagnosis
A5. FunctionaI Dysphagia
I. Sense of solid and/or liquid foods sticking,
lodging, or passing abnormally through the
esophagus; and
A4. GIobus
I. Persistent or intermittent, nonpainful
sensation of a lump or foreign body in
the throat
:. Occurrence of the sensation between meals
,. Absence of dysphagia or odynophagia
. Absence of evidence that gastroesophageal
diagnosis
A1. GIobus
I. The persistent or intermittent sensation of a
lump or foreign body in the throat;
:. Occurrence of the sensation between meals;
,. Absence of dysphagia and odynophagia; and
. Absence of pathologic gastroesophageal
with a recognized pathologic basis (e.g.,
scleroderma of the esophagus).
ome lll cr|ter|o do not |nc|ude unspec|j|ed
junct|ono| esophogeo| d|sorder os |n ome ll.
A6. Unspecied FunctionaI
EsophageaI Disorder
I. Unexplained symptoms attributed to the
esophagus that do not ft into the previously
described categories; AND
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8. lunct|ono| Costroduodeno|
u|sorders
8. lunct|ono| Costroduodeno|
u|sorders
Note moor chonges |n c|oss|fcot|on jor d,speps|o
ond nouseo ond vom|t|ng d|sorders
B1. FunctionaI Dyspepsia
Must |nc|ude:
I. /NEORMORE of the following:
a. Bothersome postprandial fullness
b. Early satiation
c. Epigastric pain
d. Epigastric burning
AND
:. No evidence of structural disease (including
at upper endoscopy) that is likely to explain
the symptoms
diagnosis
B!u. Postprundul Dstress Syndrome
Must |nc|ude one or both oj the jo||ow|ng:
I. Bothersome postprandial fullness,
occurring after ordinary-sized meals, at
least several times per week
:. Early satiation that prevents fnishing a
regular meal, at least several times per
week
diagnosis
Support|ve cr|ter|o
I. Upper abdominal bloating or
postprandial nausea or excessive belching
can be present
:. Epigastric pain syndrome may coexist

B1. FunctionaI Dyspepsia
I. Persistent or recurrent symptoms (pain
or discomfort centered in the upper
abdomen);
:. No evidence of organic disease (including
at upper endoscopy) that is likely to explain
the symptoms; AND
,. No evidence that dyspepsia is exclusively
relieved by defecation or associated with the
onset of a change in stool frequency or stool
form.
B!u. Ulcer-lke dyspepsu
Pain centered in the upper abdomen is the
predominant (most bothersome) symptom.
B!b. Dysmotlty-lke dyspepsu
An unpleasant or troublesome nonpainful
sensation (discomfort) centered in the
upper abdomen is the predominant
symptom; this sensation may be
characterized by or associated with upper
abdominal fullness, early satiety, bloating,
or nausea.
B!c. Unspeced (nonspecc) dyspepsu
Symptomatic patients whose symptoms
do not fulfll the criteria for ulcer-like or
dysmotility-like dyspepsia.
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B!b. pgustrc Pun Syndrome
I. Pain or burning localized to the
epigastrium of at least moderate severity,
at least once per week
:. The pain is intermittent
,. Not generalized or localized to other
abdominal or chest regions
. Not relieved by defecation or passage of
fatus
,. Not fulflling criteria for gallbladder and
sphincter of Oddi disorders
diagnosis
Support|ve cr|ter|o
I. The pain may be of a burning quality, but
without a retrosternal component
:. The pain is commonly induced or
relieved by ingestion of a meal, but may
occur while fasting
,. Postprandial distress syndrome may
coexist
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B2. BeIching Disorders
B2u. Aerophugu
I. Troublesome repetitive belching at least
several times a week
:. Air swallowing that is objectively
observed or measured
diagnosis
B2b. Unspeced xcessve Belchng
I. Troublesome repetitive belching at least
several times a week
:. No evidence that excessive air swallowing
underlies the symptom
diagnosis
B2. Aerophagia
or more |n the preced|ng 12 months oj:
I. Air swallowing that is objectively observed;
AND
:. Troublesome repetitive belching.
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B3. Nausea and Voniting Disorders
B3u. Chronc ldoputhc Nuuseu
I. Bothersome nausea occurring at least
several times per week
:. Not usually associated with vomiting
,. Absence of abnormalities at upper
endoscopy or metabolic disease that
explains the nausea
diagnosis
B3b. Iunctonul Yomtng
I. On average one or more episodes of
vomiting per week
:. Absence of criteria for an eating disorder,
rumination, or major psychiatric disease
according to DSM-IV
,. Absence of self-induced vomiting and
chronic cannabinoid use and absence
of abnormalities in the central nervous
system or metabolic diseases to explain
the recurrent vomiting
diagnosis
B3. FunctionaI Voniting
I. Frequent episodes of vomiting, occurring
on at least three separate days in a week over
three months;
:. Absence of criteria for an eating disorder,
rumination, or major psychiatric disease
according to DSM-IV;
,. Absence of self-induced and medication-
induced vomiting; AND
. Absence of abnormalities in the gut or
central nervous system, and metabolic
diseases to explain the recurrent vomiting.
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B3c. Cyclc Yomtng Syndrome
u|ognost|c cr|ter|o
I. Stereotypical episodes of vomiting
regarding onset (acute) and duration
(less than one week)
:. Three or more discrete episodes in the
prior year
,. Absence of nausea and vomiting between
episodes
Support|ve cr|ter|o
History or family history of migraine
headaches
B4. Runination 5yndrone in AduIts
Must |nc|ude both oj the jo||ow|ng:
I. Persistent or recurrent regurgitation of
recently ingested food into the mouth with
subsequent spitting or remastication and
swallowing
:. Regurgitation is not preceded by retching
Support|ve cr|ter|o
I. Regurgitation events are usually not
preceded by nausea
:. Cessation of the process when the
regurgitated material becomes acidic
,. Regurgitant contains recognizable food
with a pleasant taste
7he ome lll cr|ter|o c|oss|j, rum|not|on os o
junct|ono| gostroduodeno| d|sorder. ln the ome ll
c|oss|fcot|on, rum|not|on wos cons|dered o junc-
t|ono| esophogeo| d|sorder.
A2. Runination 5yndrone
I. Persistent or recurrent regurgitation of
recently ingested food into the mouth with
subsequent remastication and swallowing;
:. Absence of nausea and vomiting;
,. Cessation of the process when the
regurgitated material becomes acidic; AND
. Absence of pathologic gastroesophageal
with a recognized pathologic basis as the
primary disorder.
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C.lunct|ono| 8owe| u|sorders C.lunct|ono| 8owe| u|sorders
C1. lrritabIe BoweI 5yndrone
u|ognost|c cr|ter|on*
Recurrent abdominal pain or discomfort at
least 3 days/month in last 3 months associated
with TWOORMORE of the following:
I. Improvement with defecation
:. Onset associated with a change in frequency
of stool
,. Onset associated with a change in form
(appearance) of stool
Criterion fulflled for the last , months with
diagnosis
Discomfort` means an uncomfortable
sensation not described as pain.
In pathophysiology research and clinical trials,
a pain/discomfort frequency of at least : days
a week during the screening evaluation is
recommended for subject eligibility.
C1. lrritabIe BoweI 5yndrone
|n the preced|ng 12 months oj o5dom|no| d|scom-
jort or po|n thot hos two out oj three jeotures:
I. Relieved with defecation; ANDOR
:. Onset associated with a change in frequency
of stool; ANDOR
,. Onset associated with a change in form
(appearance) of stool.
S,mptoms thot Cumu|ot|ve|, Support the
u|ognos|s oj lrr|to5|e 8owe| S,ndrome
- Abnormal stool frequency (for research
purposes abnormal` may be defned as
greater than , bowel movements per day
and less than , bowel movements per week);
- Abnormal stool form (lumpy/hard or loose/
watery stool);
- Abnormal stool passage (straining, urgency,
or feeling of incomplete evacuation);
- Passage of mucus;
- Bloating or feeling of abdominal distension
C2. FunctionaI BIoating
I. Recurrent feeling of bloating or visible
distension at least , days/month in the last
, months
:. Insumcient criteria for a diagnosis of
functional dyspepsia, irritable bowel
syndrome, or other functional GI disorder
diagnosis
C2. FunctionaI AbdoninaI BIoating
I. Feeling of abdominal fullness, bloating, or
visible distension; AND
:. Insumcient criteria for a diagnosis of
functional dyspepsia, irritable bowel
syndrome, or other functional disorder.
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C3. FunctionaI Constipation
I. Must include TWOORMORE of the following:
a. Straining during at least :,% of
defecations
b. Lumpy or hard stools in at least :,% of
defecations
c. Sensation of incomplete evacuation for
at least :,% of defecations
d. Sensation of anorectal obstruction/
blockage for at least :,% of defecations
e. Manual maneuvers to facilitate at
least :,% of defecations (e.g., digital
evacuation, support of the pelvic foor)
f. Fewer than three defecations per week
:. Loose stools are rarely present without the
use of laxatives
,. Insumcient criteria for irritable bowel
syndrome
diagnosis
C3. FunctionaI Constipation
|n the preced|ng 12 months oj two or more oj:
I. Straining > I/ of defecations;
:. Lumpy or hard stools > I/ of defecations;
,. Sensation of incomplete evacuation > I/ of
defecations;
. Sensation of anorectal obstruction/blockage
> I/ of defecations;
,. Manual maneuvers to facilitate > I/ of
defecations (e.g., digital evacuation, support
of the pelvic foor); ANDOR
o. < , defecations per week.
Loose stools are not present, and there are
insumcient criteria for IBS.
C4. FunctionaI Diarrhea
Loose (mushy) or watery stools without pain
occurring in at least ,,% of stools
diagnosis
C4. FunctionaI Diarrhea
I. Loose (mushy) or watery stools
:. Present > ,/ of the time; AND
,. No abdominal pain.
C.5. Unspecied FunctionaI BoweI
Disorder
Bowel symptoms not attributable to an
organic etiology that do not meet criteria for
the previously defned categories
diagnosis
C5. Unspecied FunctionaI BoweI
Disorder
Bowel symptoms in the absence of organic
disease that do not ft into the previously
defned categories of functional bowel
disorders.
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u. lunct|ono| A5dom|no| Po|n
S,ndrome
u. lunct|ono| A5dom|no| Po|n
D. FunctionaI AbdoninaI Pain
5yndrone
I. Continuous or nearly continuous
abdominal pain
:. No or only occasional relationship of pain
with physiological events (e.g., eating,
defecation, or menses)
,. Some loss of daily functioning
. The pain is not feigned (e.g., malingering)
,. Insumcient symptoms to meet criteria for
another functional gastrointestinal disorder
that would explain the pain
diagnosis
D1. FunctionaI AbdoninaI
Pain 5yndrone
At |eost months oj:
I. Continuous or nearly continuous
abdominal pain; AND
:. No or only occasional relationship of pain
with physiological events (e.g., eating,
defecation, or menses); AND
,. Some loss of daily functioning; AND
. The pain is not feigned (e.g., malingering),
AND
,. Insumcient criteria for other functional
gastrointestinal disorders that would
explain the abdominal pain.
7he ome lll Cr|ter|o do not |nc|ude Unspec|fed
lunct|ono| A5dom|no| Po|n
D2. Unspecied FunctionaI
AbdoninaI Pain
This is functional abdominal pain that fails to
reach criteria for functional abdominal pain
syndrome.
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L. lunct|ono| Co||5|odder ond
Sph|ncter oj 0dd| u|sorders
L. lunct|ono| u|sorders oj the 8|||or,
7roct ond the Poncreos
E. FunctionaI GaIIbIadder and
5phincter of Oddi Disorders
u|ognost|c cr|ter|o
Must |nc|ude ep|sodes oj po|n |ocoted |n the
ep|gostr|um ondlor r|ght upper quodront
ond ull oj the jo||ow|ng:
I. Episodes lasting ,o minutes or longer
:. Recurrent symptoms occurring at diferent
intervals (not daily)
,. The pain builds up to a steady level
. The pain is moderate to severe enough to
interrupt the patient`s daily activities or lead
to an emergency department visit
,. The pain is not relieved by bowel
movements
o. The pain is not relieved by postural change
,. The pain is not relieved by antacids
8. Exclusion of other structural disease that
would explain the symptoms
Support|ve cr|ter|o
The pain may present with one or more of the
following:
I. Associated with nausea and vomiting
:. Radiates to the back and/or right infra
subscapular region
,. Awakens from sleep in the middle of the
night
!. Iunctonul Gullbludder Dsorder
u|ognost|c cr|ter|o
I. Criteria for functional gallbladder and
sphincter of Oddi disorder and
:. Gallbladder is present
,. Normal liver enzymes, conjugated
bilirubin, and amylase/lipase
E1. GaIIbIadder Dysfunction
Lp|sodes oj severe steod, po|n |ocoted |n the ep|-
gostr|um ond r|ght upper quodront, ond o|| oj the
jo||ow|ng:
I. Symptom episodes last ,o minutes or more,
with pain-free intervals;
:. Symptoms have occurred on one or more
occasions in the previous I: months;
,. The pain is steady and interrupts daily
activities or requires consultation with a
physician;
. There is no evidence of structural
abnormalities to explain the symptoms;
,. There is abnormal gallbladder functioning
with regard to emptying.
E2. 5phincter of Oddi Dysfunction
Lp|sodes oj severe steod, po|n |ocoted |n the ep|-
gostr|um ond r|ght upper quodront, ond o|| oj the
jo||ow|ng:
I. Symptom episodes last ,o minutes or more,
with pain-free intervals; AND
:. Symptoms have occurred on one or more
occasions in the previous I: months; AND
,. The pain is steady and interrupts daily
activities or requires consultation with a
physician;AND
o. There is no evidence of structural
abnormalities to explain the symptoms.
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2. Iunctonul Blury Sphncter o( Odd
Dsorder
u|ognost|c cr|ter|o
I. Criteria for functional sphincter of Oddi
disorder
:. Normal amylase/lipase
Support|ve cr|ter|on
Elevated serum transaminases, alkaline
phosphatase, or conjugated bilirubin
temporarily related to at least two pain
episodes
3. Iunctonul Puncreutc Sphncter o(
Odd Dsorder
u|ognost|c cr|ter|o
I. Criteria for functional gallbladder and
sphincter of Oddi Disorder and
:. Elevated amylase/lipase
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l. lunct|ono| Anorecto| u|sorders l. lunct|ono| u|sorders oj
the Anus ond ectum
F1. FunctionaI FecaI lncontinence
I. Recurrent uncontrolled passage of
fecal material in an individual with a
developmental age of at least years and ONE
ORMORE of the following:
a. Abnormal functioning of normally
innervated and structurally intact
muscles
b. Minor abnormalities of sphincter
structure and/or innervation
c. Normal or disordered bowel habits, (i.e.,
fecal retention or diarrhea)
d. Psychological causes
AND
:. Exclusion of ALL of the following:
a. Abnormal innervation caused by
lesion(s) within the brain (e.g.,
dementia), spinal cord, or sacral nerve
roots, or mixed lesions (e.g., multiple
sclerosis), or as part of a generalized
peripheral or autonomic neuropathy
(e.g., due to diabetes)
b. Anal sphincter abnormalities associated
with a multisystem disease (e.g.
scleroderma)
c. Structural or neurogenic abnormalities
believed to be the major or primary cause
of fecal incontinence.
Criteria fulflled for the last , months
F1. FunctionaI FecaI lncontinence
ecurrent uncontro||ed possoge oj jeco| moter|o|
jor ot |eost one month, |n on |nd|v|duo| w|th o
deve|opmento| oge oj ot |eost + ,eors, ossoc|oted
w|th:
I. Fecal impaction; OR
:. Diarrhea; OR
,. Nonstructural anal sphincter dysfunction.
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F2. FunctionaI AnorectaI Pain
I2u. Chronc Proctulgu
I. Chronic or recurrent rectal pain or
aching
:. Episodes last :o minutes or longer
,. Exclusion of other causes of rectal pain
such as ischemia, infammatory bowel
disease, cryptitis, intramuscular abscess,
anal fssure, hemorrhoids, prostatitis, and
coccygodynia
diagnosis
Chronic proctalgia may be further
characterized into levator ani syndrome or
unspecified anorectal pain based on digital
rectal examination.
I2u.!. Levutor An Syndrome
u|ognost|c cr|ter|on
Symptom criteria for chronic proctalgia
and tenderness during posterior traction
on the puborectalis
I2u.2. Unspeced Iunctonul
Anorectul Pun
Symptom criteria for chronic proctalgia
but no tenderness during posterior
traction on the puborectalis
F2. FunctionaI AnorectaI Pain
I2u. Levutor An Syndrome
At |eost 12 weeks, wh|ch need not 5e consecu-
t|ve, |n the preced|ng 12 months oj:
I. Chronic or recurrent rectal pain or
aching;
:. Episodes last :o minutes or longer; AND
,. Other causes of rectal pain such as
ischemia, infammatory bowel disease,
cryptitis, intramuscular abscess, fssure,
hemorrhoids, prostatitis, and solitary
rectal ulcer have been excluded.
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I2b. Proctulgu Iugux
u|ognost|c cr|ter|o
I. Recurrent episodes of pain localized to
the anus or lower rectum
:. Episodes last from seconds to minutes
,. There is no anorectal pain between
episodes
For research purposes criteria must be fulflled
for , months; however, clinical diagnosis and
evaluation may be made prior to , months.
I2b. Proctulgu Iugux
I. Recurrent episodes of pain localized to
the anus or lower rectum;
:. Episodes last from seconds to minutes;
AND
,. There is no anorectal pain between
episode
F3. FunctionaI Defecation Disorders
I. The patient must satisfy diagnostic criteria
for functional constipation
:. During repeated attempts to defecate must
have ATLEASTTWO of the following:
a. Evidence of impaired evacuation, based
on balloon expulsion test or imaging
b. Inappropriate contraction of the pelvic
foor muscles (i.e., anal sphincter or
puborectalis) or less than :o% relaxation
of basal resting sphincter pressure by
manometry, imaging, or EMG
c. Inadequate propulsive forces assessed by
manometry or imaging
diagnosis
'' Diagnostic criteria for functional
constipation:
() Must include TWOORMORE of the following:
(a) Straining during at least :,% of defecations,
(b) Lumpy or hard stools in at least :,% of
defecations, (c) Sensation of incomplete
evacuation for at least :,% of defecations, (d)
Sensation of anorectal obstruction/blockage
for at least :,% of defecations, (e) Manual
maneuvers to facilitate at least :,% of defecations
(e.g., digital evacuation, support of the pelvic
foor), (f ) Fewer than three defecations per week.
() Loose stools are rarely present without the
use of laxatives.
() There are insufncient criteria for irritable
bowel syndrome.
F3. PeIvic FIoor Dyssynergia
I. The patient must satisfy diagnostic criteria
for functional constipation in Diagnostic
criteria C3;
:. There must be manometric, EMG, or
radiologic evidence for inappropriate
contraction or failure to relax the pelvic
foor muscles during repeated attempts to
defecate;
,. There must be evidence of adequate
propulsive forces during attempts to
defecate, AND
. There must be evidence of incomplete
evacuation.
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I3u. Dyssynergc De(ecuton
Inappropriate contraction of the pelvic foor
or less than :o% relaxation of basal resting
sphincter pressure with adequate propulsive
forces during attempted defecation
I3b. lnudequute De(ecutory Propulson
Inadequate propulsive forces with or
without inappropriate contraction or less
than :o% relaxation of the anal sphincter
during attempted defecation

Roma III Ap B

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