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Validation of the Rome III Criteria and Alarm Symptoms for Recurrent Abdominal Pain in Children

Gijsbers, Carolien F.M.*; Benninga, Marc A.; Schweizer, Joachim J.; Kneepkens, C.M. Frank§; Vergouwe, Yvonne||; Büller, Hans A.||

Journal of Pediatric Gastroenterology and Nutrition: June 2014 - Volume 58 - Issue 6 - p 779–785
doi: 10.1097/MPG.0000000000000319
Original Articles: Gastroenterology

Objectives: Rome criteria were formulated to define functional gastrointestinal disorders (Rome III criteria, 2006) excluding organic diagnoses when alarm symptoms were absent. The aims of the study were to validate the Rome III criteria as to their capacity to differentiate between organic and functional abdominal pain and to assess the role of alarm symptoms in this differentiation.

Methods: During 2 years all of the patients (ages 4–16 years) presenting with recurrent abdominal pain (Apley criteria) and referred to secondary care were included. Clinical diagnoses were based on protocolized evaluation and intervention with 6-month follow-up. Alarm symptoms were registered. Rome III criteria for functional pain syndromes were assigned independently. Descriptive statistical analyses were performed.

Results: In 200 patients (87 boys, mean age 8.8 years), organic (17%), functional (40%), combined organic and functional (9%), spontaneous recovery (27%), and other (8%) clinical diagnoses were established. Alarm symptoms were found in 57.5% (organic causes 56%, functional causes 61%). The evaluation for Rome symptom clusters revealed symptoms of irritable bowel syndrome in 27%, functional dyspepsia in 15%, functional abdominal pain in 28%, functional abdominal pain syndrome in 14.5%, and no pain syndrome in 15.5%. Rome diagnoses, based on symptoms and absence of alarm symptoms, predicted functional clinical diagnosis with sensitivity 0.35 (95% confidence interval 0.27–0.43), specificity 0.60 (0.46–0.73), positive predictive value 0.71 (0.61–0.82), and negative predictive value of 0.24 (0.17–0.32).

Conclusions: The Rome III criteria for abdominal pain are not specific enough to rule out organic causes. Alarm symptoms do not differentiate between organic and functional abdominal pain.

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*Juliana Children's Hospital/Haga Teaching Hospital, The Hague

Emma Children's Hospital/Academic Medical Centre, Amsterdam

Willem-Alexander Children's Hospital/Leiden University Medical Centre, Leiden

§VU University Medical Centre, Amsterdam

||Erasmus Medical Centre, Rotterdam, The Netherlands.

Address correspondence and reprint requests to Carolien F.M. Gijsbers, Department of Paediatric Gastroenterology, Juliana Children's Hospital/Haga Teaching Hospital, Sportlaan 600, 2566 MJ, The Hague, The Netherlands (e-mails:

Received 16 January, 2014

Accepted 16 January, 2014

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

The authors report no conflicts of interest.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,