Systematic review and meta-analysis compares Rome III and Rome IV criteria for functional abdominal pain disorder prevalence

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Gut and liver Published May 15, 2026 Medically reviewed May 15, 2026 Study authors: Jeong Yi Deun, Kim Soeun, Son Yejun, Kim Tae Hyeon, Smith Lee, Hajek André, Kang Jiseung, Hahn Jong … PubMed ↗ DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Note that Rome IV criteria yield lower FAPD prevalence estimates than Rome III due to stricter definitions.

This systematic review and meta-analysis examines the prevalence of functional abdominal pain disorder (FAPD) and its four subtypes in the general population. The scope includes a global setting where studies estimated FAPD prevalence based on either Rome III or Rome IV diagnostic criteria. The authors synthesized data to compare pooled prevalence rates between these two sets of criteria.

The meta-analysis found that the overall pooled prevalence of FAPD was 10.89% (95% CI, 9.51% to 12.48%) when combining all criteria. When using Rome III criteria specifically, the pooled prevalence rate was 11.84% (95% CI, 10.29% to 13.61%). In contrast, the pooled prevalence rate using Rome IV criteria was 8.42% (95% CI, 6.10% to 11.62%).

Specific prevalence rates under Rome IV criteria were approximately one in 23 individuals for functional dyspepsia, one in 51 for irritable bowel syndrome, one in 68 for abdominal migraine, and one in 115 for functional abdominal pain not otherwise specified. Females exhibited higher prevalence rates than males. The authors state that studies involving estimation of FAPD prevalence based on Rome III or IV criteria are limited. The diagnostic criteria of Rome IV are stricter than those of Rome III, which likely affects the estimated prevalence of FAPD and its subtypes.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

PMID40852741

View Original Abstract ↓

BACKGROUND/AIMS: Despite the global burden of functional abdominal pain disorder (FAPD) and its four subtypes (irritable bowel syndrome [IBS], functional dyspepsia [FD], abdominal migraine [AM], and functional abdominal pain not otherwise specified [FAP-NOS]), studies involving an estimation of FAPD prevalence based on the Rome III or IV criteria are limited. Therefore, we aimed to estimate the prevalence of FAPD and its four subtypes. METHODS: A comprehensive literature search was conducted in PubMed/MEDLINE, Embase, Google Scholar, and the Cochrane Library. Studies that were performed with the general population and applied Rome III or IV diagnostic criteria were included. Data were extracted to estimate the prevalence of FAPD using a random-effects model with 95% confidence intervals (CIs). Heterogeneity was assessed using the I statistic. The study protocol was preregistered with PROSPERO (CRD420251004116). RESULTS: The overall prevalence of FAPD was 10.89% (95% CI, 9.51% to 12.48%), with pooled prevalence rates of 11.84% (10.29% to 13.61%) with the Rome III criteria and 8.42% (6.10% to 11.62%) with the Rome IV criteria. With the Rome III criteria, IBS had the highest prevalence, while FD had the lowest. In contrast, with the Rome IV criteria, the prevalence of IBS, AM, and FAP-NOS decreased, whereas FD became the most prevalent, affecting approximately one in 23 individuals, compared to one in 51 individuals affected by IBS, one in 68 individuals affected by AM, and one in 115 individuals affected by FAP-NOS. Additionally, females exhibited higher prevalence rates of FAPD and all its subtypes than males. CONCLUSIONS: The diagnostic criteria of Rome IV are stricter than those of Rome III, which likely affects the estimated prevalence of FAPD and its subtypes.