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中华诊断学电子杂志 ›› 2016, Vol. 04 ›› Issue (03) : 184 -190. doi: 10.3877/cma.j.issn.2095-655X.2016.03.010

所属专题: 文献

消化系统疾病与心身医学观

功能性胃肠道疾病罗马诊断标准的历史变迁及标准Ⅳ
徐三荣1,()   
  1. 1. 200040 上海,复旦大学附属华山医院消化科
  • 收稿日期:2016-07-05 出版日期:2016-08-26
  • 通信作者: 徐三荣

The historical change of diagnostic criteria of Rome and Rome Ⅳ about functional gastrointestinal disorders

Sanrong Xu1,()   

  1. 1. Department of Gastroenterology, Huashan Hospital Affiliated to Fudan University, Shanghai 200040, China
  • Received:2016-07-05 Published:2016-08-26
  • Corresponding author: Sanrong Xu
  • About author:
    Corresponding author: Xu Sanrong, Email:
引用本文:

徐三荣. 功能性胃肠道疾病罗马诊断标准的历史变迁及标准Ⅳ[J]. 中华诊断学电子杂志, 2016, 04(03): 184-190.

Sanrong Xu. The historical change of diagnostic criteria of Rome and Rome Ⅳ about functional gastrointestinal disorders[J]. Chinese Journal of Diagnostics(Electronic Edition), 2016, 04(03): 184-190.

功能性胃肠道疾病(FGIDs)是最常见的消化科疾病,依据形态学和生理学异常来识别,这两种异常经常合并存在,包括动力紊乱、迷走兴奋性增高、黏膜和免疫功能改变、肠道菌群改变、中枢神经系统信息处理改变。肠-脑互动紊乱的研究是基于使用特殊的诊断标准,因此要进行FGIDs领域中新认识的传播。罗马Ⅳ标准在罗马Ⅲ基础上:(1)更新了基础和临床文献;(2)提供了胃肠道微生态、脑-肠互动、药物基因学组、生物-心理-社会、性别和对FGIDs跨学科认识的新信息;(3)尽可能减少不准确或偶尔会遭到诟病的名称;(4)采用最新的诊断标准;(5)使患者病症体验、生理学亚组或生物标记的资料具体化,以便采用更有针对性的治疗。笔者对FGIDs领域作了历史的回顾,从动力和结构紊乱对FGIDs作了区分,讨论了与罗马Ⅲ的不同,回顾了罗马委员会的工作过程,为FGIDs提供了一个生物-心理-社会的、病理生理学的定义,为患者的治疗提供一个手段。

Functional gastrointestinal disorders (FGIDs), the most common diseases in gastroenterology, are recognized by morphologic and physiological abnormalities which often occur in combination including motility disturbance, increased vagal excitability, altered mucosal and immune function, altered gut microbiota, and altered central nervous system processing.Research on these gut-brain interaction disorders is based on using specific diagnostic criteria.The Rome Foundation has played a pivotal role in creating diagnostic criteria, thus new knowledge in the field of FGIDs should be disseminated.Rome Ⅳ is a compendium of the accumulated knowledge since Rome Ⅲ was published 10 years ago.It improves upon Rome Ⅲ by: (1)updating the basic and clinical literatures; (2)offering new information on gut microenvironment, gut-brain interactions, pharmacogenomics, biopsychosocial, gender and cross-disciplinary understandings of FGIDs; (3)reducing the use of imprecise and occasionally stigmatizing terms when possible; (4)using updated diagnostic criteria; (5)incorporating information on illness experience, and physiological subgroups or biomarkers of patient that may lead to more targeted treatment.This introductory article offers a historical overview of the FGIDs field, differentiates FGIDs from motility and structural disorders, discusses the changes from Rome Ⅲ, reviews the Rome committee, provides a biopsychosocial and pathophysiological conceptualization of FGIDs, and offers an approach to patient care.

表1 功能性胃肠道疾病类别
A食管疾病 ?
A1功能性胸痛 A4癔症球
? A2功能性烧心 ? A5功能性吞咽困难
? A3反流性高敏感 ? ?
B胃十二指肠疾病 ?
? B1功能性消化不良 ? B3恶心和呕吐疾病
? B1a餐后不适综合征 ? B3a慢性恶心呕吐综合征
? B1b上腹痛综合征 ? B3b周期性呕吐综合征
? B2嗳气疾病 ? B3c大麻样剧吐综合征
? B2a胃上部过度嗳气 ? B4反刍综合征
? B2b胃过度嗳气C肠道疾病 ? ?
? C1肠易激综合征 ? C2功能性便秘
? IBS-C ? C3功能性腹泻
? IBS-D ? C4功能性胀气/紧缩
? IBS-M ? C5非特异性功能性肠病
? IBS-U ? C6鸦片类药物诱导的便秘
D中枢介导的胃肠道疼痛疾病 ?
? D1中枢介导性腹痛综合征 ? ?
? D2吸毒成瘾性肠综合征/鸦片类药物引起的胃肠道痛觉过敏 ? ?
E胆囊和Oddi括约肌疾病 ?
? E1胆道痛 ? ?
? E1a功能性胆囊疾病 ? ?
? E1b功能性胆道性Oddi疾病 ? ?
? E2功能性胰腺性Oddi疾病 ? ?
F直肠肛门疾病 ?
? F1大便失禁 ? F3功能性排便障碍
? F2功能性直肠肛门痛 ? F3a排便动力不足
? F2a肛提肌综合征 ? F3b排便协同失调
? F2b非特异性直肠肛门痛 ? ?
? F2c痉挛性肛门痛 ? ?
G儿童FGIDs:新生儿/婴儿 ?
? G1婴儿反流 ? G5功能性腹泻
? G2反刍综合征 ? G6婴儿排便困难
? G3周期性呕吐综合征 ? G7功能性便秘
? G4婴儿肠绞痛 ? ?
H儿童FGIDs:儿童/青少年 ?
? H1功能性恶心呕吐疾病 ? H2b肠易激综合征
? H1a周期性呕吐综合征 ? H2c腹型偏头痛
? H1b功能性恶心和功能性呕吐 ? H2d功能性腹痛-NOS
? ? H1b1功能性恶心 ?
? ? H1b2功能性呕吐 H3功能性排便障碍
? H2功能性腹痛疾病 H3a功能性便秘
? H2a功能性消化不良 H3b容纳能力不良性大便失禁
? ? H2a1餐后不适综合征 ?
? ? H2a2上腹疼痛综合征 ?
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