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Systematic review and meta-analysis compares Rome III and Rome IV criteria for functional abdominal pain disorder prevalenceNew Rome IV rules show fewer people have functional abdominal pain compared to older guidelines

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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.

Doctors use special checklists to find out if someone has stomach pain that has no clear cause. These checklists are called Rome criteria. A large study looked at how many people have these problems using two different versions of the checklist. The older version is called Rome III, and the newer one is Rome IV.

When doctors used the older Rome III rules, about 12 out of every 100 people were found to have these stomach issues. However, when they used the newer Rome IV rules, only about 8 out of every 100 people qualified. This means the new rules are harder to meet, so fewer people get the diagnosis.

The study also looked at specific types of stomach pain. For example, one type affects about one in 23 people, while another affects only one in 68. Girls were found to have these problems more often than boys. Because the rules changed, the numbers we see today might be lower than they really are.

This is important because it shows how changing the checklist changes the count of sick people. Doctors need to know this so they do not worry too much if fewer people are diagnosed now. The real number of people with these problems is probably somewhere in the middle of the two counts.

What this means for you:
Newer rules for stomach pain make it harder to get a diagnosis, so fewer people are counted as having the problem.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedMay 2026
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.
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