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Abstract
Functional gastrointestinal disorders (FGIDs), the most common diagnoses in gastroenterology
are recognized by morphological and physiological abnormalities that often occur in
combination including motility disturbance, visceral hypersensitivity, altered mucosal
and immune function, altered gut microbiota and altered central nervous system processing.
Research on these gut-brain interaction disorders is based on using specific diagnostic
criteria. The Rome Foundation has played a pivotal role in creating diagnostic criteria
thus operationalizing the dissemination of new knowledge in the field of FGIDs. Rome
IV is a compendium of the knowledge accumulated since Rome III was published 10 years
ago. It improves upon Rome III by: 1) updating the basic and clinical literature,
2) offering new information on gut microenvironment, gut-brain interactions, pharmacogenomics,
biopsychosocial, gender and cross cultural understandings of FGIDs, 3) reduces the
use of imprecise and occassionally stigmatizing terms when possible, 4) uses updated
diagnostic algorithms, 5) incorporates information on the patient illness experience,
and physiological subgroups or biomarkers that might lead to more targeted treatment.
This introductory article sets the stage for the remaining 17 articles that follow
and offers an historical overview of the FGIDs field, differentiates FGIDs from motility
and structural disorders, discusses the changes from Rome III, reviews the Rome committee
process, provides a biopsychosocial pathophysiological conceptualization of FGIDs,
and offers an approach to patient care.