MDCalc

Rome IV Diagnostic Criteria for Centrally Mediated Abdominal Pain Syndrome (CAPS)

Official Rome IV criteria for the diagnosis of centrally mediated abdominal pain syndrome (CAPS).

Use in patients with chronic abdominal pain that is poorly related to gut function for at least 6 months.

Patients with any of the following features must be evaluated clinically for other diagnoses to explain their abdominal pain even though centrally mediated abdominal pain syndrome may be present:

  • Signs or symptoms of gastrointestinal bleeding.

  • Unexplained iron deficiency anemia.

  • Unintentional weight loss.

  • Palpable abdominal mass or lymphadenopathy on exam.

  • Family history of GI cancer.

  • Onset of symptoms age ≥50 years and have not had age-appropriate colon cancer screening.

  • Sudden or acute onset or new change in bowel habit.

  • Recurrent nausea and vomiting.

Must have the following:

For 3 months prior with symptom onset ≥6 months ago

Some degree of gastrointestinal dysfunction may be present
Daily function could include impairments in work, intimacy, social/leisure, family life, and caregiving for self or others

Diagnostic Result

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Advice

If diagnosis not met (negative):

Current symptoms are unlikely to be caused by centrally mediated abdominal pain syndrome. Consider further assessment as clinically indicated. 

If meets diagnosis (positive):

Likely diagnosis of centrally mediated abdominal pain syndrome. Consider initiating treatment.

Management

Studies regarding treatments in centrally mediated abdominal pain syndrome are limited. Data is often extrapolated from the treatment of other disorders of gut-brain interaction. The treatment of centrally mediated abdominal pain syndrome relies on establishing a productive patient-provider relationship.

Possible treatments may include:

  • Neuromodulators (e.g. tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors, tetracyclic antidepressants, atypical antipsychotics).

  • Behavioral therapies (e.g. cognitive behavioral therapy, hypnotherapy, mindfulness based therapy).

The choice of therapy is outside the scope of this calculator and will depend on clinical context.

Critical Actions

This calculator should only be used in patients who do not have signs or symptoms suggestive of a structural/mechanical, metabolic or systemic cause of their symptoms based on clinical history, physical exam and initial work-up.

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