Dr Chang reviews important changes in the Rome V diagnostic criteria for disorders of gut-brain interaction, which she detailed during her lecture at the American College of Gastroenterology Scientific Meeting in Nashville, October 12-14.

Lin Chang, MD, is a professor of Medicine and Vice-Chief of the Vatche and Tamar Manoukian Division of Digestive Diseases at the David Geffen School of Medicine at UCLA and director of the Walter and Shirley Wang Center for Integrative Digestive Health in Los Angeles, California.

Rome V Updates Diagnosis of Gut-Brain Interaction Disorders

• Rome V, launched in May 2026, required the work of 144 investigators in 27 countries over 7 years and includes changes in diagnostic criteria for many disorders of gut-brain interaction.
• Esophageal disorders should follow the framework of the Lyon Consensus for GERD and the Chicago Classification of Motility Disorders. Random esophageal biopsies for eosinophilic esophagitis are no longer supported.
• Abdominal discomfort has been included in criteria for irritable bowel syndrome (IBS) criteria due to differing views of pain in different cultures. Criteria now distinguish recurrent IBS pain from continuous pain, which is indicative of centrally mediated abdominal pain syndrome (CAPS). CAPS treatment emphasizes brain-gut behavioral therapy and central neuromodulators.
• Predominant nausea and vomiting should prompt consideration of chronic nausea and vomiting syndrome or gastroparesis rather than functional dyspepsia; symptom assessment guides diagnosis and testing.
• Rome V adds inability to belch and adult abdominal migraine, recognizes rectal hypersensitivity and hyposensitivity, and lowers the diagnostic threshold for dyssynergic defecation.

I'm Lin Chang. I'm a professor of medicine and gastroenterologist at UCLA Los Angeles, California. And I have the privilege of giving this year's ACG Edward J. Burke lecture. And this lecture is about what's new in Rome V. This is a set of criteria and information about disorders of gut-brain interaction that was launched in May of 2026. This occurs every 10 years, and I'm going to summarize what's new, but I particularly wanted to focus on what's applicable in clinical practice. So I'm going to review the whole process, which took 7 years to do, 144 investigators from 27 countries.

So there are criteria chapters that talk about the diagnostic criteria for IBS, functional dyspepsia, but there's also a lot of chapters and content of all the years, this past 10 years of the scientific literature to inform the criteria and other aspects of managing disorders of gut-brain interaction. So there are chapters on intestinal microenvironment, psychosocial aspects, gender, patient perspective, age, race, also the physiology, basic science and translational.

For the criteria chapters, which there's something new in most of them. For esophageal disorders, for example, you ground the framework in using the Lyon Consensus for GERD and the Chicago Classification of Motility Disorders. There's also new information that you don't do random esophageal biopsies like we used to do looking for eosinophilic esophagitis. Now, it is only recommended to do it if you see some endoscopic finding that you're suspicious of and you want to biopsy it—dysphagia and when patients have chest pain with eating. If they don't meet those criteria, you’re not looking for Barrett's esophagus, then you actually don't have to do random biopsies.

There's also new criteria for IBS, where we are trying to differentiate IBS from central and mediated abdominal pain syndrome, which is called CAPS, where IBS has recurrent abdominal pain, not continuous like everyday waking hours. Because in those patients, they may meet the other criteria for CAPS. And the reason why that's important is CAPS is treated with centrally mediated treatments like brain-gut behavior therapy, central neuromodulators, where IBS can be treated with peripherally acting agents or centrally acting therapies. And the criteria is abdominal pain or discomfort. We brought discomfort back in because there are a lot of countries and patients who experience discomfort, but not pain related to diarrhea and/or constipation. So that's what's new for the IBS criteria.

The other aspect that we tried to do is take out ‘functional’ out of the diagnostic criteria when we could. Instead of functional constipation, it's chronic constipation, but functional diarrhea stays as functional diarrhea because you can't really use the term chronic diarrhea. There's many different causes of what is termed chronic diarrhea. And for the functional dyspepsia, it's really trying to differentiate postprandial distress syndrome and epigastric pain syndrome. But I think one of the things that they did that was important, if someone has predominant nausea and vomiting, it's really the individual is guided to move out of functional dyspepsia. Think of chronic nausea and vomiting syndrome or gastroparesis. So nausea is going to be a very important symptom that you obtain from your patient to guide what diagnosis the patient has or the test.

And then there's two new conditions. One is called inability to belch, which is something that a lot of the clinicians have noticed and the Rome members have noticed that patients have. So it's where they feel like they need to belch, but they can't belch. And it's because their upper esophageal sphincter can't relax. And so that is very bothersome to people.

And then the other new diagnosis that they always had in pediatrics, but we didn't have in adults, but we all recognize that you do see it in adults as well.  It's called abdominal migraine. And when you say that word, that term to a patient, they will know what you mean. It's very stereotypical episodic, fall to your knees, pain for a few hours to a few days. It's not a chronic condition, and that's something that is being recognized in adults.

And there's some changes in the anorectal disorders of recognizing rectal hypersensitivity, rectal hyposensitivity, and a lowered threshold to meet criteria for dyssynergic defecation where you have pelvic floor dysfunction.

And the last thing that I would say about Rome V is that the pediatric classification has completely changed. It used to be from neonates, toddlers, adolescents, now it's following adults. It's upper gut and lower gut. They have some newer diagnoses as well, like different types of feeding disorders. So a lot has changed all based on scientific evidence and also getting information from patients to inform us of what's bothersome, what are the symptom thresholds or frequency thresholds to guide the questionnaire and the diagnosis of these disorders.

So I hope that you'll read all the content. We have gastroenterology manuscripts, chapters, online manuscripts as well. So there's a lot of data for primary care physicians as well. So host of information, I hope this is all helpful to patients, clinicians, and the scientific research community.