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Rome IV Criteria for Functional Dyspepsia​

Rome IV Criteria for Functional Dyspepsia​
B1. Functional dyspepsia*
Diagnostic criteria
  1. One or more of the following:
a. Bothersome postprandial fullness
b. Bothersome early satiation
c. Bothersome epigastric pain
d. Bothersome epigastric burning
AND
  1. No evidence of structural disease (including at upper endoscopy) that is likely to explain the symptoms
B1a. Postprandial distress syndrome
Diagnostic criteria
Must include one or both of the following at least three days per week:
  1. Bothersome postprandial fullness (ie, severe enough to impact on usual activities)
  1. Bothersome early satiation (ie, severe enough to prevent finishing a regular-size meal)
No evidence of organic, systemic, or metabolic disease that is likely to explain the symptoms on routine investigations (including at upper endoscopy)
Supportive remarks
  • Postprandial epigastric pain or burning, epigastric bloating, excessive belching, and nausea can also be present
  • Vomiting warrants consideration of another disorder
  • Heartburn is not a dyspeptic symptom but may often coexist
  • Symptoms that are relieved by evacuation of feces or gas should generally not be considered as part of dyspepsia
Other individual digestive symptoms or groups of symptoms, eg, from gastroesophageal reflux disease and the irritable bowel syndrome may coexist with PDS
B1b. Epigastric pain syndrome
Diagnostic criteria
Must include at least one of the following symptoms at least one day a week:
  1. Bothersome epigastric pain (ie, severe enough to impact on usual activities)
AND/OR
  1. Bothersome epigastric burning (ie, severe enough to impact on usual activities)
No evidence of organic, systemic, or metabolic disease that is likely to explain the symptoms on routine investigations (including at upper endoscopy)
Supportive remarks
  1. Pain may be induced by ingestion of a meal, relieved by ingestion of a meal, or may occur while fasting
  1. Postprandial epigastric bloating, belching, and nausea can also be present
  1. Persistent vomiting likely suggests another disorder
  1. Heartburn is not a dyspeptic symptom but may often coexist
  1. The pain does not fulfill biliary pain criteria
  1. Symptoms that are relieved by evacuation of feces or gas generally should not be considered as part of dyspepsia
Other digestive symptoms (such as from gastroesophageal reflux disease and the irritable bowel syndrome) may coexist with EPS
PDS: postprandial distress syndrome; EPS: epigastric pain syndrome.
* Must fulfill criteria for PDS and/or EPS.
¶ Criteria fulfilled for the last three months with symptom onset at least six months before diagnosis.
Original table modified for this publication. Stanghellini V, Chan FKL, Hasler WL, et al. Gastroduodenal disorder. Gastroenterology 2016; 150:1380. Table used with the permission of Elsevier Inc. All rights reserved.
Graphic 108003 Version 1.0

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