Rome III: The Functional Gastrointestinal Disorders

Abstract

When it was first convened in 1990, the Rome committee sought to bring order to the largely amorphous world of functional gastrointestinal disorders (FGIDs). Sixteen years later, in the third edition of the Rome criteria, the authors continue their quest to update and refine the classification of FGIDs. The first 6 chapters are dedicated to neurogastroenterology, pharmacology, the role of gender and culture, and the psychologic aspects of FGIDs. Although a basic understanding of these aspects of FGIDs can be helpful, the level of detail in a few of these initial chapters (ie, the fundamentals of neurogastroenterology) is more than is necessary for the average clinician. As in past issues, the discussion of FGIDs is organized by organ system. Each disorder’s criteria are clearly listed at the beginning of the chapter followed by a detailed discussion of appropriate diagnostic and therapeutic strategies. Salient studies are succinctly summarized when appropriate, allowing clinicians the opportunity to quickly reference supporting data. Rome III does include several important changes to the previous edition. The time frame criteria required for FGID diagnosis has been simplified, several new classification categories have been created (mainly in the realm of pediatric FGIDs), and diagnostic criteria have been amended for functional dyspepsia and irritable bowel syndrome. Rome III is clearly written and well organized. Although the book’s size and subject matter may at first seem overwhelming, its excellent use of tables and diagnostic flow charts allows for easy application to medical practice. The patient questionnaires and scoring algorithms contained in the appendix are arguably the most useful to the practicing clinician. Also highlighted in this section is the specific testing necessary to exclude the presence of underlying structural disease before diagnosis of a particular FGID. Recognizing the inherent difficulty in adopting new guidelines, the authors even include the old Rome II criteria side-by-side with the updated criteria. Recommendation: In all, the authors of Rome III have done an excellent job of creating a resource on FGIDs that is comprehensive and detailed while also being clinically relevant and easy-to-use. A must have for any practicing gastroenterologist.