Rome IV: What You Need to Know May 2016

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Rome-logo@2xRome IV FAQs

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Why Should there be Rome IV?

This is a logical question since we have gone through 3 prior versions over the last 20 years. However, much like the DSM system (now version 5) an update occurs when the need exists. Since publication of Rome III 7 years ago there is much new information accumulating in all scientific areas relating to these disorders. Rome IV will come out in 2016, fully 10 years after the Rome III version. In addition we are rapidly moving away from consensus to evidence based knowledge but consensus (“Delphi approach”) will be used at times when evidence is not available and the judgment of experts is needed.

We also expect to show with Rome IV that we can finally discard the functional-organic dichotomy that tends to stigmatize these disorders. Functional GI disorders are now understood as having abnormalities in mucosal immune dysfunction and the microbiota and the work in biomarkers is likely to be a feature for understanding these disorders in the future. Also scientific investigation and clinical practice is a global phenomenon and we must to expand our knowledge to accommodate a multinational context. Finally there are many residual questions that need clarification as we move forward; for example, “How can we best understand the relationship between IBS-C and functional constipation?” or “what is the latest physiological understanding for sub classifying functional dyspepsia?”

What is new for Rome IV?

Perhaps the most important and novel initiative relative to previous Rome criteria versions is that we are prospectively acquiring knowledge in predefined areas of interest prior to activation of the Rome IV chapter committees in 2013. We have several working teams now charged to provide the needed content in areas such as gut microflora, symptom assessment in Asia, the role of food and diet, and the nature of severity for FGIDs. In addition there are several support committees who are working with the chapter committees to enhance the Rome IV work. This includes concurrent development of the Rome IV questionnaire and its validation, and a systematic review committee that will provide evidence based information to the chapter committees to help answer important questions to help the chapter committees have up to date information. There is also a primary care committee to 1) clarify how primary care clinicians manage patients with these FGIDs and 2) to “translate” the criteria into ways that are more relevant for primary care. There is also a cross cultural committee that will provide information about how to conduct research in FGIDs that would be acceptable around the world. Finally we have a multi-dimensional clinical profile committee that is creating a means to capture systematically the full dimensionality of a patient in order to provide better therapeutic options for patients. This information will be available to the committees for their use over the subsequent two years.

How will Rome IV be available?

By 2016 most all information acquisition will be by computer access. This provides more opportunities for readers since they may purchase unlimited access (which will be available to Rome IV sponsors and members), download individual chapters or even do free text searching for information. In addition we will be incorporating cross-links to other chapters and have considerably more graphic material from our computer based learning programs. We will also publish a supply of printed books including special editions for pediatrics, and primary care as well as the Rome IV questionnaires. Finally are planning to have several translations of the Rome IV book available within one year of the English publication.

What is the Multi-Dimensional Clinical Profile?

A diagnostic classification system that provides a categorical diagnosis such as Rome or DSM criteria is helpful particularly for classifying patients for research studies. However, it may not capture the full dimensionality of a patient’s clinical profile. For example an IBS patient seen in primary care may be treated quite differently from a patient with the same diagnosis seen at a major medical center, the latter having with more severe symptoms, psychological co-morbidities or more severe physiological disturbances. Therefore the multi-dimensional clinical profile permits an ability to characterize the patient in several dimensions. This will not only be in terms of the diagnostic criteria as currently exists, but also in terms of any clinical modifiers (e.g., IBS-C, D, or M), the impact of the condition (mild, moderate or severe), the presence of any psychosocial modifiers, or the degree of physiological dysfunction and biomarkers.