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Rome IV Diagnostic Criteria for Functional Diarrhea

Symptom-based diagnosis of chronic non-painful loose stools.

Rome IV Diagnostic Criteria for Functional Diarrhea
Loose (mushy) or watery stools, present in ≥75% of stools
Assessed without use of antidiarrheal agents.
Stools occur without predominant abdominal pain or bothersome bloating
Onset ≥6 months ago, with criteria fulfilled for the last 3 months
ResultCriteria not met

Does not meet Rome IV criteria for functional diarrhea; reconsider IBS with diarrhea or an organic cause of chronic diarrhea.

When to use

  • Adult with chronic loose or watery stools who lacks the pain/bloating pattern of IBS, after organic causes have been reasonably excluded.

Formula

Diagnosis requires all of: loose/watery stools in ≥75% of stools; absence of predominant abdominal pain or bothersome bloating; symptom onset ≥6 months before diagnosis with criteria met for the last 3 months.

Pearls and pitfalls

  • Distinguished from IBS-D mainly by the absence of predominant pain/bloating; the stool pattern threshold is otherwise similar.

References

  1. Mearin F, Lacy BE, Chang L, et al. Bowel Disorders. Gastroenterology. 2016;150(6):1393-1407.