The Rome V Diagnostic Questionnaire for Disorders of Gut-Brain Interaction in Adults (R5DQ) translates the Rome V diagnostic criteria into questions that can be understood and reported by patients and research subjects. The intended uses of the R5DQ 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.

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

The entire questionnaire is available, as well as the following modules:

IBS Module: (IBS with predominant constipation, IBS with predominant diarrhea, IBS with mixed bowel habits, IBS unclassified (IBS-U)

Bowel Module: IBS: (IBS with predominant constipation, IBS with predominant diarrhea, IBS with mixed bowel habits, IBS unclassified (IBS-U): Chronic constipation, Functional diarrhea, Functional abdominal bloating, Unclassified bowel disorders, Opioid-induced constipation)

Centrally Mediated Disorders of GI Pain Module: (Centrally mediated disorders of gastrointestinal pain syndrome (CAPS), Abdominal migraine, Narcotic bowel syndrome (NBS)/Opioid-induced GI hyperalgesia)

Gastroduodenal Module: (Functional dyspepsia: Postprandial distress syndrome (PDS), Epigastric pain syndrome (EPS): Nausea and vomiting disorders: Chronic nausea vomiting syndrome (CNVS), Cyclical vomiting syndrome (CVS), Cannabinoid hyperemesis syndrome (CHS), Rumination syndrome, Excessive Belching Disorders: Excessive supragastric belching, Excessive gastric belching, Inability to belch syndrome)

Esophageal Module: (Functional chest pain, Functional heartburn, Reflux hypersensitivity, Globus, Functional dysphasia)

Biliary Module: (Biliary pain)

Anorectal Module: (Fecal Incontinence; Anorectal pain disorders: Levator ani syndrome, Proctalgia fugax)

Parent-report form for Children and Adolescents.

The entire questionnaire is available, as well as the following six modules:

Pediatric Upper DGBI

Esophageal Disorders (Aerophagia, Supragastric belching, Non-reflux esophageal pain disorder, Reflux hypersensitivity)

Functional Feeding Disorders (Anticipatory feeding disorder, Hunger dysregulation disorder, Hypersensitive dysphagia, Medically Triggered feeding disorder)

Gastroduodenal Disorders (Chronic nausea syndrome, Cyclic vomiting syndrome, Functional dyspepsia, Rumination)

Pediatric Lower DGBI

Abdominal Pain Disorders (Abdominal Migraine, Abdominal Pain NOS, Biliary Pain Syndrome, Centrally Mediated Abdominal Pain Syndrome, IBS)

Defecation and Anorectal Disorders (Functional Constipation, Functional Diarrhea, Non-Retentive Fecal Incontinence, Infant Dyschezia, Proctalgia Fugax)

Discomfort Disorders (Functional abdominal bloating, Infant distress syndrome)

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