Rome IV Diagnostic Questionnaires

The Rome IV Diagnostic Questionnaire for Functional Gastrointestinal Disorders in Adults (R4DQ) translates the Rome IV diagnostic criteria into questions that can be understood and reported by patients and research subjects. The intended uses of the R4DQ are (1) to provide inclusion criteria for clinical research studies, (2) to serve as case definitions for epidemiological surveys, and (3) to assist clinicians in arriving at a provisional diagnosis. Diagnostic questionnaires were also developed for pediatric FGIDs.

The following Rome IV questionnaires are available upon request. Additional instruments are also available. Please visit our Copyright and Licensing page for more information.

For Adults

  1. A self-report integrated questionnaire for diagnosis of all functional gastrointestinal disorders in adults (R4DQ), including alarm symptoms or red flags to alert clinicians to consider testing for alternative medical disorders.
  2. Six modules based on the Rome IV criteria that can be used to screen for the following single diagnoses or groups of diagnoses:
    1. Irritable Bowel Syndrome (IBS)
    2. Bowel Disorders (Includes all bowel disorders and all centrally mediated pain disorders)
    3. Gastroduodenal Disorders
    4. Esophageal Disorders
    5. Gallbladder and Sphincter of Odi Disorders
    6. Anorectal Disorders
  3. Guidelines and Flags for Mental Health Involvement

For Children & Adolescents

  1. Rome IV Diagnostic Questionnaire on Pediatric Functional Gastrointestinal Disorders (R4PDQ) – Child: Self-report form for Children and Adolescents (10 years and older)
  2. R4PDQ – Child: Parent-report form for Children (4 years and older)
  3. R4PDQ – Toddler: Parent-report form for Neonates and Toddlers (0-3 years)

 

For questions regarding these questionnaires or scoring algorithms, please contact us.