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a Chair, Committee on
Functional Gastroduodenal Disorders, Multinational Working Teams to
Develop Diagnostic Criteria for Functional Gastrointestinal Disorders
(Rome II), Department of Medicine, University
of Sydney, Penrith, Australia, b Co-Chair, Committee on Functional
Gastroduodenal Disorders, Multinational Working Teams to Develop
Diagnostic Criteria for Functional Gastrointestinal Disorders (Rome
II), Department
of Internal Medicine and Gastroenterology,
Bologna, Italy, c University of Edinburgh,
Edinburgh, Scotland, UK, d Milton S Hershey Medical Center,
Hershey, PA, USA, e Digestive System Research Unit, Hospital General
Vall D'Hebron, Barcelona,
Spain, f Division of
Gastroenterology and Hepatology, Academic Medical Center,
Amsterdam, The Netherlands
Correspondence to: Nicholas J Talley, MD, Professor of Medicine, University of Sydney, Clinical Sciences Building, Nepean Hospital, PO Box 63, Penrith NSW 2751, Australia.
While widely used in research, the 1991 Rome criteria for
the gastroduodenal disorders, especially symptom subgroups in
dyspepsia, remain contentious. After a comprehensive literature
search, a consensus-based approach was applied, supplemented by input
from international experts who reviewed the report. Three functional gastroduodenal disorders are defined. Functional dyspepsia is persistent or recurrent pain or discomfort centered in the upper abdomen; evidence of organic disease likely to explain the symptoms is
absent, including at upper endoscopy. Discomfort refers to a
subjective, negative feeling that may be characterized by or associated
with a number of non-painful symptoms including upper abdominal
fullness, early satiety, bloating, or nausea. A dyspepsia subgroup
classification is proposed for research purposes, based on the
predominant (most bothersome) symptom: (a)
ulcer-like dyspepsia when pain (from mild to severe) is the predominant
symptom, and (b) dysmotility-like dyspepsia
when discomfort (not pain) is the predominant symptom. This
classification is supported by recent evidence suggesting that
predominant symptoms, but not symptom clusters, identify subgroups with
distinct underlying pathophysiological disturbances and responses to
treatment. Aerophagia is an unusual complaint characterized by air
swallowing that is objectively observed and troublesome repetitive
belching. Functional vomiting refers to frequent episodes of recurrent
vomiting that is not self-induced nor medication induced, and occurs in
the absence of eating disorders, major psychiatric diseases,
abnormalities in the gut or central nervous system, or metabolic
diseases that can explain the symptom. The current classification
requires careful validation but the criteria should be of value in
future research.
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