In December 2014, the chapter committees for the Rome IV project met in Rome to work collaboratively on their chapters. This gathering of top experts also included a Harmonization Meeting with all chairs and co-chairs of the chapters present to discuss any overlapping or outstanding issues. Much was accomplished during this time, and we are well on our way to finalizing the Rome IV printed volumes. While in Rome, the committees spent hours working together as well as with our illustrator, Jerry Schoendorf, and our copy editor, Jackie Mollenauer. We currently have 470+ color images for the online document and 139 for the printed volumes.
The most important and novel initiative relative to previous Rome criteria versions is we have prospectively acquired knowledge in predefined areas of interest prior to activation of the Rome IV chapter committees which began in 2013. Noted below are the several active support committees and working teams who have set up the knowledge for the chapter committees who began working in 2011.
Rome IV Support Committees
- Questionnaire Development and Validation (William Whitehead, chair). This committee will ensure that the Rome IV questionnaire accurately reflects the criteria, is translatable into key languages and will be well validated.
- Systematic Review (Paul Moayyedi, chair). This committee is charged to review the existing body of literature relevant to the chapter committee topics, and provide advance articles to the chapter committees as well as do systematic reviews and meta-analyses until finalization of the documents.
- Primary care (Pali Hungin, Chair). This committee is working to publish an article on the ways primary care physicians understand and apply their knowledge in the care of patients with IBS and other FGIDs. This will help in their second objective: to apply the new Rome IV criteria when produced in a way that is beneficial to primary care physicians and health care extenders. We anticipate this will lead to a book on the Rome IV guidelines for primary care.
- Multi-dimensional Clinical Profile (Doug Drossman, Chair). This new initiative will bring knowledge to clinicians beyond the diagnostic criteria: to provide guidelines about the clinical profile of individual patients that will help in selecting more focused treatment options. The current diagnostic criteria helps to classify patients for research studies. However, it does not capture the full dimensionality of a patient’s clinical profile. For example an IBS patient seen in primary care may be treated quite differently from a patient with the same diagnosis seen at a major medical center, the latter having with more severe symptoms, psychological co-morbidities or more severe physiological disturbances. Therefore the multi-dimensional clinical profile permits an ability to characterize the patient not only in terms of the diagnosis as currently exists but also in terms of any clinical modifiers (e.g., IBS-C, D, or M), the impact of the condition (mild, moderate or severe), the presence of any psychosocial modifiers, or the degree of physiological dysfunction and biomarkers. This will help to direct the type and degree of treatments.
Rome IV Working Team Committees
The Working Team Committees have or are currently working to produce publication reviews in preselected areas of interest that are needed for the field. They are being used by the chapter committees in their work. The topics include:
- Severity in Irritable Bowel Syndrome (Drossman DA, Chang L., et al. Amer. J. Gastroenterology 2011; 106:1749-1759)
- Intestinal Microbiota in Functional Bowel Disorders (Simren M. Barbara, G. et al. Gut 2012, online)
- Food/Diet and Functional GI Disorders (Chey W, Tack J et al. The American Journal of Gastroenterology 108, 694-697 (May 2013) | doi:10.1038/ajg.2013.62)
- Asian working team (Gwee, KA, Whitehead WE. Et al. ongoing)
- Cross cultural and multi-national research (Sperber A, et al. ongoing)
We believe that by 2016 most all new information will be occurring by computer access. Therefore we plan to publish our chapters online. Online access provides more opportunities for readers since they may purchase unlimited access (which will be available to Rome IV sponsors and members), download individual chapters or even do free text searching for information. In addition we will be incorporating cross-links to other chapters and have considerably more graphic material from our computer based learning slide set and algorithms. We will also publish a supply of printed books including special editions for pediatrics, and primary care as well as the Rome IV questionnaires. Finally we are planning to have several translations of the Rome IV book available within one year of the English publication.
We are pleased to announce that the Rome IV articles will appear as a special edition in the journal Gastroenterology in early 2016 and the associate editors will be Douglas Drossman, MD and William Hasler, MD. This special issue will be published around the time of the Rome IV book and online book chapters.
Rome IV Chapters
The Rome IV book has 19 chapters (in two volumes or online) and contains several new chapters. The table of contents is:
- The Functional Gastrointestinal Disorders and the Rome IV Process
- Fundamentals of Neurogastroenterology – Basic Science
- Fundamentals of Neurogastroenterology – Physiology/Motility-Sensation
- Intestinal Microenvironment and Functional GI Disorders
- Pharmacological, Pharmacokinetic and Pharmacogenomic Aspects of Functional GI Disorders
- Age, Gender, Woman’s Health and the Patient
- Multi-cultural Aspects of Functional Gastrointestinal Disorders
- Biopsychosocial Aspects of Functional Gastrointestinal Disorders
- Functional Esophageal Disorders
- Functional Gastroduodenal Disorders
- Functional Bowel Disorders
- Central Nervous System Disorders of Gastrointestinal Pain
- Functional Gallbladder and Sphincter of Oddi Disorders
- Functional Anorectal Disorders
- Childhood Functional Gastrointestinal Disorders: Neonate/Toddler
- Childhood Functional Gastrointestinal Disorders: Child/Adolescent
- Design of Treatment Trials for Functional Gastrointestinal Disorders
- Development and Validation of the Rome IV Diagnostic Questionnaire
- History of Functional GI Disorders and the Rome Foundation
Rome IV Chapter Committee Disclosures
As part of the Rome IV committee work, chapter members disclosed potential disclosed consultancy associations with pharmaceutical sponsors. This information can be viewed here.