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Rome IV Diagnostic Criteria for Functional Gallbladder Disorder
Symptom-based diagnosis of biliary-type pain with a structurally normal gallbladder.
Rome IV Diagnostic Criteria for Functional Gallbladder Disorder
Biliary pain present
Epigastric and/or right-upper-quadrant pain that builds to a steady level and lasts ≥30 minutes, recurs at different (non-daily) intervals, is severe enough to interrupt activities or prompt an ED visit, is not substantially related (<20%) to bowel movements, and is not substantially relieved by postural change or acid suppression.
Gallbladder in situ
No gallstones, sludge, or microlithiasis on imaging
No other structural explanation for the symptoms (e.g., normal liver enzymes, conjugated bilirubin, amylase/lipase)
ResultCriteria not met
Does not meet Rome IV criteria for functional gallbladder disorder; reconsider cholelithiasis, another biliary/pancreatic structural cause, or a non-biliary source of pain.
When to use
- Recurrent episodic biliary-type pain in a patient with an intact gallbladder and no gallstones on imaging.
Formula
Diagnosis requires all of: biliary pain (epigastric/RUQ pain, builds to a steady level ≥30 min, non-daily, severe, not related to bowel movements, not relieved by posture or acid suppression); gallbladder present; absence of gallstones or sludge; absence of another structural explanation.
Pearls and pitfalls
- Normal liver enzymes, conjugated bilirubin, and pancreatic enzymes support the diagnosis and argue against an alternative structural cause.