RomeⅣ：新しい機能性胃腸障害の診断基準は世界を旅する

2016年10月17日にウイーンで行われたヨーロッパ消化器病週間において、

機能性胃腸障害の新しい診断基準であるローマⅣの解説が最高責任者であるDrossman博士（ノースカロライナ大学）よって行われた。

ローマIVでの主な変更点は以下である。

• 「腸 - 脳の相互作用の障害」という用語の再定義。必要でないときに「機能」という用語の削除。
• オピオイド誘発性便秘、麻薬性腸症候群、カンナビノイド悪阻症候群および還流過敏症などの新しい診断の追加。
• 診断基準のしきい値の変更による臨床的意義の改善。
• オッディ（SOD）括約筋障害基準の改訂。
• 過敏性腸症候群（IBS）とそのサブタイプの診断基準から「不快感」を削除。

https://www.eurekalert.org/pub_releases/2016-10/sh-ri-101016.php

(Vienna, October 18, 2016) European clinicians and research scientists attending UEG Week 2016 have welcomed the publication of new criteria for the diagnosis and classification of functional gastrointestinal (GI) disorders, together with the launch of several major initiatives designed to enhance understanding of these disorders and help clinicians in the care of their patients. Delegates attending UEG Week in Vienna embraced the initiatives, which have been inspired by publication of the new Rome IV criteria for functional GI disorders and were showcased today by Dr Douglas A. Drossman, the current President of the Rome Foundation.

Speaking at UEG Week, Dr Drossman outlined the need to update the definitions and conceptual understanding of functional GI disorders, leading to the development of the Rome IV classification and the research and educational initiatives that have followed. "The Rome III criteria were published in 2006 and, in the last 10 years, we have seen unprecedented progress in our understanding of functional GI disorders and now have better treatments available for many of them," he said. "In developing the Rome IV criteria, we wanted to include new diagnoses, emphasize the importance of the gut¬-brain interaction in the pathophysiology of these conditions, and improve their diagnosis and treatment using new learning tools."

What's new in Rome IV?

The Rome IV criteria contain a number of major changes, which were based on both new evidence and expert consensus. Major changes in Rome IV include:

• The redefinition of functional GI disorders as 'disorders of the gut-brain interaction' and the removal of the term, 'functional' when not needed.
• The addition of new diagnoses, including opioid-induced constipation, narcotic bowel syndrome, cannabinoid hyperemesis syndrome and reflux hypersensitivity.
• Threshold changes for diagnostic criteria to improve their clinical meaningfulness.
• Revision of sphincter of Oddi (SOD) disorder criteria
• Reconceptualization of irritable bowel syndrome (IBS) and its sub-types, with removal of the term 'discomfort' from its diagnostic criteria.

"These changes reflect our growing understanding of many different aspects of functional GI disorders and they should help support future research and enhance clinical practice," said Dr Drossman. "We now want to help clinicians in Europe and around the world to understand the new criteria, integrate them into their own diagnostic work-ups and optimize their patient management."

To aid in the communication of the Rome IV concepts to clinicians, the educational materials have been published as the Rome IV 2-volume textbook and also supplementary clinically oriented books. These include diagnostic algorithms, multimodal treatment using the Multi-Dimensional Clinical Profile, as well as paediatric and primary care books. "In this manner, the clinician can find the book that is best targeted to his or specific interests" said Dr Drossman.

Rome IV Interactive Clinical Decision Toolkit

As a means to further reach the needs of clinicians, the Rome Foundation has been working with new software to develop a powerful on-line, interactive toolkit that presents a combination of Rome IV diagnostic algorithms and Multidimensional Clinical Profile (MDCP) treatment guidelines. The toolkit guides clinicians through the complex challenges of working with patients with functional GI disorders, with users seeing all relevant decision pathways, and, by inputting their patients' information, activating the pathways that lead to treatment recommendations for optimal outcomes.

"Both the Rome IV diagnostic criteria and the MDCP guidelines are innovative in their learning approaches and we are pleased to have been able to combine these approaches in this interactive on-line toolkit," explained Dr Drossman. "We anticipate that clinicians will be able to develop a more comprehensive knowledge and optimize the care of their patients by accessing the most up-to-date information developed by world experts."

References

1. Drossman DA, Chang L, Chey WD, Kellow J, Tack J, Whitehead WE (eds). Rome IV functional gastrointestinal disorders: disorders of gut-brain interaction. Raleigh, NC: Rome Foundation, 2016.

2. Drossman DA, Chang L, Chey WD, Kellow J, Tack J, Whitehead WE and the Rome IV Committees (eds). Rome IV Multidimensional Clinical Profile for Functional Gastrointestinal Disorders (2nd edition). Raleigh, NC: Rome Foundation, 2016.

Notes to Editors

For further information, or to arrange an interview with Dr Douglas Drossman, please contact Luke Paskins on +44 (0)1444 811099 or media@ueg.eu

About Dr Douglas Drossman

Dr Drossman is the current President of the Rome Foundation and his research relates to the clinical, epidemiological, psychosocial and treatment aspect of functional GI disorders. He has served as the Associated Editor of the journal Gastroenterology and has written over 500 articles and book chapters.

http://www.medscape.com/viewarticle/870437?src=wnl_edit_tpal&uac=231753EV

An interactive online clinical decision toolkit that combines the Rome IV criteria for diagnosis and classification of functional gastrointestinal (GI) disorders with multidimensional clinical profile (MDCP) treatment guidelines was on display at United European Gastroenterology (UEG) Week 2016 in Vienna.

"We are going beyond the textbooks to help clinicians make decisions about diagnosis and treatment, even in primary care," said Douglas Drossman, MD, professor emeritus at University of North Carolina Center for Functional GI and Motility Disorders in Chapel Hill, who is president of the Rome Foundation.

"The software system incorporates the algorithm book and the MDCP book into an online toolkit, into which clinicians can put information and get recommendations about diagnosis and treatment. That's the highlight," Dr Drossman told Medscape Medical News.

The Rome IV criteria, launched earlier this year, replaced the Rome III criteria, which were published in 2006.

'Unprecedented' Progress

The update was sorely needed, said Dr Drossman. In the past 10 years, there has been "unprecedented progress" in our understanding of functional GI disorders, and there are now better treatments available for these patients, he explained in a news release.

One of the major changes in the updated criteria is the redefinition of functional GI disorders; they are now considered "disorders of the gut–brain interaction." Another change is the removal of the term "functional" when it is not needed.

There have also been threshold changes to improve the clinical meaningfulness of diagnostic criteria, including a revision of criteria for sphincter of Oddi dysfunction and a reconceptualization of irritable bowel syndrome and its subtypes, with the term "discomfort" removed from its diagnostic criteria.

"We want to help clinicians in Europe and around the world understand the new criteria, integrate them into their own diagnostic workups, and optimize their patient management," Dr Drossman said.

We want to help clinicians in Europe and around the world understand the new criteria.

Rome III set the standard for the selection of patients for clinical trials, and the US Food and Drug Administration requires those criteria to be met for treatment trials. "So there has been an acceptance of this in the academic and the clinical trial arenas, but it hasn't reached the clinicians," Dr Drossman told Medscape Medical News.

He has been traveling the globe to raise awareness of Rome IV. "In the last 3 months, I was in Korea, Brazil, Cartagena, London, and now Vienna, and after that, I go to China and Mexico, and then Japan in March," he said. "Every country wants to know what is new for Rome IV."

The educational materials available from the Rome Foundation include a two-volume Rome IV textbook, as well as supplementary clinically oriented books that contain diagnostic algorithms, multimodal treatments that adhere to MDCP guidelines, and books targeted to pediatrics and primary care.

In this way, the clinician can find the book that is best suited to their specific interests, said Dr Drossman. And the online toolkit, which is expected to become available in the next several months, will enhance the value of the books by guiding clinicians through the complex challenges of working with patients with functional GI disorders.

"We are trying to meet the needs of clinicians by drilling down from the textbook information to case-based methods of making a diagnosis with algorithms, and then to treatment using a multidimensional framework that also looks at quality of life, the severity of illness, and psychological issues," he explained.

Dr Drossman has disclosed no relevant financial relationships.

United European Gastroenterology (UEG) Week. Presented October 17, 2016.

Dr DrossmanはローマIVの意識を高めるために世界中を旅しています。「最近3ヶ月で、私は韓国、ブラジル、カルタヘナ、ロンドンに行きました。そして今ウィーン、その後、私は中国、メキシコ、その後、日本に行く」"と彼は言いました。「すべての国がローマIVのための新機能を知りたがっています。」