Functional dyspepsia: Not all roads seem to lead to Rome

BACKGROUND: The Rome criteria have been introduced to create order in the heterogeneity of functional dyspepsia. The applicability of these symptom-based classification systems remains controversial. GOAL: To evaluate the successive Rome criteria for functional dyspepsia in a large pool of patients with endoscopically verified functional dyspepsia. STUDY: Patients referred to a secondary care district hospital were asked to fill out a questionnaire on gastrointestinal symptoms 2 weeks before upper gastrointestinal endoscopy. Patients were classified according to the Rome I, II, and III criteria for functional dyspepsia. RESULTS: Nine hundred and twelve (70%) patients had no organic disorder explaining their symptoms. According to the Rome I, II, and III criteria, 371 (41%), 735 (81%), and 551 (60%) of these patients had functional dyspepsia, respectively. Twenty-five percent of patients had functional dyspepsia according to all 3 Rome criteria, whereas 15% was not classifiable at all. Forty-four percent and 42% of the patients, respectively, had epigastric pain syndrome and postprandial distress syndrome according to the Rome III criteria; however, 26% of all patients met both criteria and 40% was not classified at all. CONCLUSIONS: The symptom-based Rome classification of functional dyspepsia does not lead to an easily applicable and consistent system that is useful in clinical practice or scientific research.