Rome IV Diagnostic Criteria for Functional Diarrhea
Official Rome IV criteria for the diagnosis of functional diarrhea.
Use in patients with symptoms of chronic diarrhea for at least the last 6 months where there is not a clear systemic cause for diarrhea (e.g. secondary diarrhea).
Patients with any of the following features must be evaluated clinically for other diagnoses even though functional diarrhea may be present:
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Signs or symptoms of gastrointestinal bleeding.
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Unexplained iron deficiency anemia.
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Unintentional weight loss or evidence of malnutrition.
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Palpable abdominal mass or lymphadenopathy on exam.
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Family history of colon cancer and have not had age-appropriate colon cancer screening. Family history of inflammatory bowel disease or celiac disease.
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Onset of symptoms age ≥50 years and have not had age-appropriate colon cancer screening.
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Sudden or acute onset of new change in bowel habit.
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Diarrhea awakening the patient at night.
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Recent antibiotic use.
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High volume diarrhea.
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Fever.
If diagnosis not met (negative):
Symptoms unlikely to be caused by functional diarrhea. Consider further assessment as clinically indicated.
If meets diagnosis (positive):
Likely diagnosis of functional diarrhea. Consider initiating treatment.
Management of functional diarrhea may include:
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Diet modifications.
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Adequate dietary fiber intake and supplementation.
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Peripheral opioid agonists (e.g. loperamide).
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Bile acid binders (e.g. cholestyramine, colesevelam).
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Neuromodulators (e.g. tricyclic antidepressants).
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5-HT3 antagonists (e.g. ondansetron, alosetron).
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Mixed opioid agonist/antagonist (e.g. eluxadoline).
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Antibiotics (e.g. rifaximin).
Note that many of these treatment options have limited evidence in functional diarrhea specifically but are often used in, the related condition, diarrhea predominant irritable bowel syndrome (IBS-D).
The choice of therapy is outside the scope of this calculator and will depend on clinical context.
This calculator should only be used in patients where a secondary cause of diarrhea is not suspected based on clinical history, physical exam and diagnostic testing.