Rome IV Diagnostic Criteria for Functional Gallbladder Disorder
Official Rome IV criteria for the diagnosis of functional gallbladder disorder.
Use in patients with symptoms characteristic of typical biliary pain as defined by Rome IV criteria with gallbladder present.
Supportive criteria such as low ejection fraction on gallbladder scintigraphy (<40%) and normal liver enzymes, conjugated bilirubin, and amylase/lipase can aid in diagnosis.
Do NOT use these criteria in patients with:
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Atypical symptoms for biliary colic (mild, transient, constant, daily).
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Visualized cholelithiasis or microlithiasis/sludge on ultrasound or endoscopic ultrasound (EUS).
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Structural abnormalities, especially biliary dilation or liver enzymes not explained by other cause: should consider EUS or magnetic resonance cholangiopancreaticography (MRCP).
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Patients may respond to reassurance and medical treatments such as antispasmodics, neuromodulators, or ursodeoxycholic acid, although their value has not been evaluated formally.
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Consider a cholecystectomy if there is a typical clinical pattern of biliary pain and a low ejection fraction of the gallbladder. However, randomized controlled trials are needed.
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In many cases, conservative management may be considered with expectant observation.
This calculator should only be used for patients with low clinical suspicion for structural disease and adequate evaluation including liver and pancreatic enzymes, ultrasound and possibly endoscopic ultrasound or cross-sectional imaging such as magnetic resonance cholangiopancreatography if clinically indicated.
NOTE: other GI conditions such as irritable bowel syndrome and functional dyspepsia may coexist with functional gallbladder disorder.