A source for healthcare professionals to access the latest data and information on the diagnosis, treatment and management of patients with gut related disorders


Bowel disorders

Lacey B et al. Gastroenterology 2016;150:1393–1407.

Short summary

The identification and diagnosis of functional bowel disorders is challenging. These disorders are very common and patients typically present with abdominal pain, distention, bloating and/or change in bowel habits. 

Unlike other gastrointestinal (GI) disorders, functional bowel disorders are chronic conditions, with patients having experienced symptoms for over 6 months at presentation. Patients with functional bowel disorders will also be affected by recent presenting symptoms, occurring less than 3 months prior to presentation (within the last three months). Symptoms of functional bowel disorders are present at least once a week and routine clinical examination usually fails to reveal any underlying anatomic or physiologic issues.

Identification, diagnosis and treatment of these disorders is generally based on the Rome III criteria, published in 2006. In this article, Brian Lacy and his colleagues present revisions to these criteria based on advances in understanding and treatment of functional bowel disorders over the past ten years. 

The new Rome IV criteria classifies functional bowel disorders into five distinct categories: irritable bowel syndrome, functional constipation, functional diarrhoea, functional abdominal bloating/distention and unspeciļ¬ed functional bowel disorder. The Rome IV classification also introduces a sixth category called opioid-induced constipation which produces symptoms similar to functional bowel disorders and develops secondary to the actions of opioids on the GI tract and central nervous system. 

According to the authors of this study, functional bowel disorders exist as a continuum and clinicians must be aware that an assured differential diagnosis may be unachievable in some cases. However, using the new definitions outlined in this article, clinicians should be better able to identify, diagnose and treat functional bowel disorders. This should in turn improve the quality of life for patients who suffer from these disorders and have a positive economic impact on healthcare systems around the world.

Job number: JB57410GBt Date of Preparation: June 2019

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