ToolsCalculators
Rome IV Diagnostic Criteria for Functional Chest Pain
Diagnostic checklist for functional (non-cardiac, non-reflux) chest pain in adults.
Rome IV Diagnostic Criteria for Functional Chest Pain
Midline chest pain or discomfort, not of a burning quality
Cardiac causes of the pain have been excluded
Gastro-oesophageal reflux disease has been excluded as the cause
Major oesophageal motor disorders and mucosal-based oesophageal disease (e.g. eosinophilic oesophagitis) have been excluded
Criteria fulfilled for the last 3 months with symptom onset ≥6 months before diagnosis
ResultCriteria not met
Diagnosis requires midline, non-burning chest pain with cardiac, reflux, and major motility/mucosal causes excluded, for the last 3 months with onset ≥6 months before diagnosis.
When to use
- Evaluating recurrent chest pain after a cardiac cause has been excluded and reflux therapy has failed or reflux has been excluded.
Formula
Midline chest pain or discomfort, not burning in quality, with cardiac disease, GERD, and major oesophageal motor/mucosal disorders excluded, for the last 3 months with onset ≥6 months before diagnosis.
Pearls and pitfalls
- Burning-quality pain points to functional heartburn rather than functional chest pain.
- A trial of PPI therapy or ambulatory pH-impedance testing is typically used to exclude reflux before labelling pain as functional.