Gut 1999;45(Suppl 2):II43-II47 ( September )

Functional bowel disorders and functional abdominal pain

W G Thompson^a, G F Longstreth^b, D A Drossman^c, K W Heaton^d, E J Irvine^e, S A Müller-Lissner^f

^a Chair, Committee on Functional Bowel Disorders and Functional Abdominal Pain, Multinational Working Teams to Develop Diagnostic Criteria for Functional Gastrointestinal Disorders (Rome II), Emeritus Professor of Medicine, University of Ottawa, Canada, ^b Co-Chair, Committee on Functional Bowel Disorders and Functional Abdominal Pain, Multinational Working Teams to Develop Diagnostic Criteria for Functional Gastrointestinal Disorders (Rome II), Kaiser Permanente, San Diego, CA, USA, ^c Division of Digestive Diseases, University of North Carolina, Chapel Hill, NC, USA, ^d Department of Medicine, University of Bristol, Bristol, UK, ^e Department of Medicine, McMaster University, Ontario, Canada, ^f Department of Medicine, Park-Klinik, Weissensee, Berlin, Germany

Correspondence to: W Grant Thompson, MD, 7 Nesbitt Street, Nepean, Ontario K2H 8C4, Canada.

The Rome diagnostic criteria for the functional bowel disorders and functional abdominal pain are used widely in research and practice. A committee consensus approach, including criticism from multinational expert reviewers, was used to revise the diagnostic criteria and update diagnosis and treatment recommendations, based on research results. The terminology was clarified and the diagnostic criteria and management recommendations were revised. A functional bowel disorder (FBD) is diagnosed by characteristic symptoms for at least 12 weeks during the preceding 12 months in the absence of a structural or biochemical explanation. The irritable bowel syndrome, functional abdominal bloating, functional constipation, and functional diarrhea are distinguished by symptom-based diagnostic criteria. Unspecified FBD lacks criteria for the other FBDs. Diagnostic testing is individualized, depending on patient age, primary symptom characteristics, and other clinical and laboratory features. Functional abdominal pain (FAP) is defined as either the FAP syndrome, which requires at least six months of pain with poor relation to gut function and loss of daily activities, or unspecified FAP, which lacks criteria for the FAP syndrome. An organic cause for the pain must be excluded, but aspects of the patient's pain behavior are of primary importance. Treatment of the FBDs relies upon confident diagnosis, explanation, and reassurance. Diet alteration, drug treatment, and psychotherapy may be beneficial, depending on the symptoms and psychological features.


Keywords: functional bowel disorder; functional constipation; functional diarrhea; irritable bowel syndrome; functional abdominal pain; functional abdominal bloating; Rome II

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