Rome V Published: New Criteria for Disorders of Gut–Brain Interaction

Rome V, the fifth edition of the internationally established criteria for Disorders of Gut–Brain Interaction (DGBI), has been published. Ten years after Rome IV, the new edition incorporates significant scientific advances in neurogastroenterology while further refining the diagnostic criteria.

A key innovation is the clearer distinction between clinical and scientific diagnostic criteria. Rome V is thus designed to better meet the differing requirements of clinical care and research and to enable a diagnostic approach that is more closely aligned with clinical reality and patient-centered care.

What has changed regarding irritable bowel syndrome?

Some changes are particularly evident when considering irritable bowel syndrome (IBS). Among other things, “discomfort” or abdominal discomfort has been reintroduced into the clinical criteria alongside abdominal pain. The required symptom frequency has also been adjusted. Other changes include the distinction between continuous pain and cycle-associated symptoms, as well as subtyping based on the Bristol Stool Scale.

In addition, the classification of bowel disorders has been further refined overall. The previous term “Functional Bowel Disorders” has been replaced by “Bowel Disorders.” This exemplifies a fundamental approach of Rome V: Terms such as “functional,” which inadequately reflect the now-understood pathophysiological mechanisms and may in some cases be perceived as stigmatizing, should increasingly be avoided.

Advances in Neurogastroenterology

Rome V goes far beyond simply updating diagnostic criteria. The new edition reflects important scientific developments since Rome IV—ranging from the neurobiology and neuroplasticity of the enteric nervous system to neuroimmunological mechanisms and the microbiome and its interactions with the gut and brain. New technological and methodological approaches are also incorporated into the DGBI’s updated understanding.
More than 140 experts from 27 countries were involved in the development of Rome V. The result is a comprehensive international consensus document that brings together current findings from basic and clinical research and provides new impetus for diagnosis, treatment, and further research.

The contributions to Rome V have been published, among other places, in a recent issue of *Gastroenterology*.