Background Functional gastrointestinal disorders (FGIDs), now understood as disorders of gut-brain interactions, are a group of recurring gastrointestinal symptoms which after appropriate medical evaluation cannot be attributed to another medical condition. Clinical evaluation and management remain challenging. The recently updated Rome IV criteria are symptom-based guidelines enabling classification and prevalence estimates of childhood FGIDs.

Aims To determine the prevalence of FGIDs amongst children presenting to Alder Hey gastroenterology outpatient clinics according to Rome IV criteria. To compare Rome IV with clinical diagnoses and describe clinical management.

Methods The referral letters and case records of all children attending gastroenterology clinics in January 2019 were reviewed. Patients were classified according to the Rome IV criteria and diagnoses assigned following clinical assessment, investigations, and follow-up, and clinical management, were recorded.

Results In total, 53/228 (27.6%) children had an FGID according to the Rome IV criteria. Sufficient information was available to make a definite FGID diagnosis using the Rome IV criteria in 44 (83.0%) cases. The most common diagnoses were IBS (27; 42.9%) and functional constipation (13; 20.6%); 10 children (18.9%) had two FGIDs. Clinical diagnoses and clinical management varied markedly within each Rome IV diagnosis (table 1).

Conclusion Use of the Rome IV criteria in routine practice is achievable and would likely better capture the clinical burden of these common conditions through greater consistency in clinical diagnosis. In addition, use of the criteria would encourage quality improvement projects and research to better inform clinical management.