Rome V | Precision Biotics

The Rome Foundation has been at the forefront of understanding and classifying Disorders of Gut–Brain Interaction (DGBIs) for almost three decades.

The Rome Criteria provide an internationally recognised framework for diagnosing DGBIs based on characteristic symptoms, helping clinicians and researchers identify and study conditions such as irritable bowel syndrome (IBS), functional dyspepsia and constipation. Since Rome IV was published in 2016, our understanding of the complex interactions between the gut, brain, microbiota, immune system and wider patient environment has continued to evolve. Rome V, published in 2026, builds on this evidence to provide updated diagnostic criteria and clinical guidance for both adults and children. For IBS in particular, the criteria offer a more clinically focused approach to diagnosis, while continuing to recognise IBS as a disorder arising from multiple interacting mechanisms rather than a single underlying cause.

So, why was an update needed?

Quite simply, the science has moved on. Ten years of research since Rome IV have provided new insights into gut–brain interactions, diet, the gut microbiota, visceral sensitivity, motility, immune function and central processing of gastrointestinal symptoms. Rome V therefore aims to bring the diagnostic framework closer to current scientific understanding and everyday clinical practice. An important evolution is the continued move away from the older concept of "functional" gastrointestinal disorders towards DGBIs, reflecting the recognition that these symptoms have real and multifactorial biological mechanisms. Rome V also places greater emphasis on the gut microenvironment and microbiota as part of DGBI pathophysiology, alongside brain–gut interactions, diet and other mechanisms. This provides a framework in which microbiota-directed approaches can be considered as part of the broader therapeutic landscape, alongside dietary, behavioural and pharmacological interventions where appropriate.

For adults with IBS, some of the changes are subtle but clinically meaningful.

Rome V has reintroduced abdominal discomfort alongside abdominal pain, recognising that patients in different populations may describe their IBS symptoms differently. The symptom frequency threshold has also changed: abdominal pain or discomfort should be present on average at least 3 days per month, rather than at least 1 day per week as in Rome IV. Importantly, symptoms should be intermittent rather than continuous, helping distinguish IBS from centrally mediated abdominal pain syndrome. Rome V also highlights that abdominal pain or discomfort should not be exclusively or predominantly related to menstruation, supporting consideration of other causes such as dysmenorrhoea or endometriosis when appropriate. Beyond the criteria themselves, Rome V introduces more clinically oriented diagnostic and management algorithms, with greater emphasis on making a positive diagnosis and using clinical judgement rather than viewing diagnosis primarily as a process of exclusion.

The changes are particularly substantial in paediatric practice.

Rome V moves away from the age-based classification used previously and instead organises paediatric DGBIs according to anatomical region and symptom patterns, bringing greater alignment with the adult framework while retaining developmental considerations. For paediatric IBS, the core criteria continue to centre on intermittent abdominal pain associated with defecation and/or a change in stool frequency or form, with abdominal pain remaining the predominant symptom. Rome V also retains 6 years as the minimum age for an IBS diagnosis, reflecting the limited evidence for IBS in younger children. More broadly, the paediatric framework introduces and refines several diagnoses, including functional abdominal bloating, centrally mediated abdominal pain syndrome and proctalgia fugax, while replacing the term "infantile colic" with "infant distress syndrome." The new paediatric framework also recognises that DGBIs can coexist with other conditions, supporting a more nuanced approach to assessment rather than assuming that one diagnosis must explain every gastrointestinal symptom.

Ultimately, Rome V is more than a change to diagnostic criteria — it provides an opportunity to rethink how DGBIs are recognised and managed in clinical practice.

For clinicians, the updated IBS criteria may support earlier and more confident positive diagnosis, while the new diagnostic and management algorithms provide a clearer pathway for assessment and treatment. The broader framework reinforces the importance of looking beyond a single symptom or mechanism and considering the individual patient, including diet, gut–brain interactions, microbiota, psychological and social factors and symptom impact. For patients, this can help move the conversation away from "nothing being wrong" towards a clear, evidence-based explanation of their symptoms and a personalised management plan. As the evidence base continues to develop, Rome V provides a foundation for integrating emerging approaches — including microbiota-directed interventions — into a broader, multidisciplinary understanding of IBS and other DGBIs.