The ‘Con’ case. The Rome Process and Functional Gastrointestinal Disorders: the barbarians are at the gate!

In his preface to the first edition of the Functional Gastrointestinal Disorders , Douglas Drossman outlined the goals of the process that we have all come to know and love as the Rome criteria to: 1 make a positive diagnosis of these disorders, 2 understand their pathophysiology and 3 make effective treatment choices. Clinicians and clinical investigators inundated with patients for whom the only diagnostic path was one of exclusion (and mutual exhaustion) and frustrated in their attempts to compare each others clinical observations and to design therapeutic trials, flocked to Rome where the deliberations and conclusions of the cognoscenti could be received and a new way forward revealed. The functional gastrointestinal disorders (FGIDs) previously vague, often dismissed and, at times, even ridiculed by the more organic among the medical fraternity achieved, through the seal and protection of mighty Rome, a legitimacy and credibility which their advocates had long yearned for. These disorders could be crisply defined and delineated from each other; subsequent studies revealed the promise of Rome. Through the application of its criteria it became clear that these disorders were very common, were of far greater impact to those who suffered from them and their economic and social import was considerable. Very soon the world recognized that a mighty empire had emerged in their midst and that it would come to rule this vast territory for decades to come. Governments, through their regulatory agencies, acknowledged the emergence of Rome and the giants and minnows of the pharmaceutical industry stood up and recognized that, through Rome, vast riches were within sight: patient populations for clinical trials could be neatly defined, subpopulations characterized and responsive end points developed. Investigators envisaged a time when, by applying the doctrines of Rome, the pathophysiology of the various FGIDs and their subtypes would reveal themselves before their very eyes. Even the lowly clinician could now look forward to a day when he, or she, could dispense with expensive and invasive tests, look the patient in the eye and confidently deliver a positive diagnosis, because Rome had so ordained. All basked in the glory that was Rome!