The ‘Pro’ case. The Rome III criteria

A recent editorial in the journal commented that: based on their prevalence and health-economic impact, disorders of gastrointestinal (GI) motor and sensory function continue to represent a major unmet need . Although all investigators working in this field would likely concur with the statement, it is important that we are clear in our minds what conditions these disorders actually represent, and what nomenclature and classification we should use to describe and define them – in clinical practice, in research, and in discussions with regulatory and other authorities. The term functional GI disorders (FGIDs) is used to define several variable combinations of chronic or recurrent GI symptoms that cannot be explained by structural or biochemical abnormalities. In many instances, these disorders are likely to derive ultimately from a disturbance of gut function, be it motor, sensory or secretory. Moreover, because the FGIDs are defined by symptoms, they encompass many of the primary motility disorders, apart from those entities with documented histopathological lesions of the enteric nervous system (ENS) and/or central nervous system (CNS), such as achalasia or Hirschsprung s disease. For most of the FGIDs, the nature and extent of objective GI tract motor and sensory dysfunction remains unclear. It is also increasingly evident that some of the FGIDs have features in common, and overlap with, disorders in other systems such as fibromyalgia and interstitial cystitis; this suggests a more complex aetiology than once appreciated, involving brain-gut dysregulation associated with factors such as altered gut ecology, immune activation in the ENS, altered autonomic function, altered activation of CNS circuits and disorders of mood and affect. Over the previous 15 years, the Rome organization (now Rome Foundation) has worked towards achieving a better understanding and treatment of the FGIDs. One of its main activities has been the development of symptom-based criteria for the FGIDs. Given the continuing evolution and maturation of these Rome criteria over the previous two generations of publications, and with the recent publication of the latest iteration – Rome III – it is timely to reassess the current position and role of the criteria in the field. In addressing several issues relevant to Rome III, as suggested by the Editors, it will be evident that these criteria, because of the multi-factorial aetiology of the FGIDs, and despite the inherent limitations of symptom-based diagnostic criteria, remain an essential component of the research effort directed towards these disorders. It will also be evident that the criteria continue to have an important role in the clinical management of the FGIDs.