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Rome IV Diagnostic Criteria for Functional Dysphagia
Symptom-based diagnosis of esophageal dysphagia without a structural or motor cause.
Rome IV Diagnostic Criteria for Functional Dysphagia
Sense of solid and/or liquid food sticking, lodging, or passing abnormally through the esophagus
No evidence that an esophageal mucosal or structural abnormality (e.g., stricture, ring, web, tumor, esophagitis) is the cause of the symptom
No evidence that gastroesophageal reflux disease is the cause of the symptom
No evidence that eosinophilic esophagitis is the cause of the symptom
No major esophageal motor disorder present (e.g., achalasia/EGJ outflow obstruction, diffuse esophageal spasm, jackhammer esophagus, absent peristalsis)
Onset ≥6 months ago, with criteria fulfilled for the last 3 months
ResultCriteria not met
Does not meet Rome IV criteria for functional dysphagia; investigate for a structural/mucosal esophageal lesion, GERD, eosinophilic esophagitis, or a major esophageal motor disorder.
When to use
- Patient with a sensation of abnormal bolus transit through the esophagus after structural, mucosal, and motor causes have been excluded.
Formula
Diagnosis requires all of: bolus-transit sensation in the esophagus; esophageal mucosal or structural abnormality excluded as the cause; GERD excluded as the cause; eosinophilic esophagitis excluded as the cause; no major esophageal motor disorder; onset ≥6 months before diagnosis with criteria met for the last 3 months.
Pearls and pitfalls
- Endoscopy with esophageal biopsies and high-resolution manometry are required before assigning this diagnosis, since structural, mucosal, and major motor disorders must all be excluded.