The Rome diagnostic criteria for the functional bowel disorders and functional abdominal pain are used widely in research and practice. A committee consensus approach, including criticism from multinational expert reviewers, was used to revise the diagnostic criteria and update diagnosis and treatment recommendations, based on research results. The terminology was clarified and the diagnostic criteria and management recommendations were revised. A functional bowel disorder (FBD) is diagnosed by characteristic symptoms for at least 12 weeks during the preceding 12 months in the absence of a structural or biochemical explanation. The irritable bowel syndrome, functional abdominal bloating, functional constipation, and functional diarrhea are distinguished by symptom-based diagnostic criteria. Unspecified FBD lacks criteria for the other FBDs. Diagnostic testing is individualized, depending on patient age, primary symptom characteristics, and other clinical and laboratory features. Functional abdominal pain (FAP) is defined as either the FAP syndrome, which requires at least six months of pain with poor relation to gut function and loss of daily activities, or unspecified FAP, which lacks criteria for the FAP syndrome. An organic cause for the pain must be excluded, but aspects of the patient’s pain behavior are of primary importance. Treatment of the FBDs relies upon confident diagnosis, explanation, and reassurance. Diet alteration, drug treatment, and psychotherapy may be beneficial, depending on the symptoms and psychological features.

This study has shown that a stool form scale can be used to monitor change in intestinal function. Such scales have utility in both clinical practice and research.

and conclusions A questionnaire to establish the presence of 15 symptoms thought to be typical of the irritable bowel syndrome (IBS) was given to 109 unselected patients referred to gastroenterology or surgery clinics with abdominal pain or a change in bowel habit or both. Review of case records 17-26 months later established a definite diagnosis of IBS in 32 patients and of organic disease in 33. Four symptoms *were significantly more common among patients with IBS-namely, distension, relief of pain with bowel movement, and looser and more frequent bowel movements with the onset of pain. Mucus and a sensation of incomplete evacuation were also common in these patients. The more of these symptoms that were present the more likely was it that the patient's pain or altered bowel habit, or both, was due to IBS. We conclude that a careful history can increase diagnostic confidence and reduce the amount of investigation in many patients with chronic abdominal pain.

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biopsy in our patients did not show evidence of Crohn's disease, but there was unequivocal evidence of Crohn's disease elsewhere. Furthermore, the failure of symptoms in patients who do not smoke to respond to treatment suggests peptic ulceration associated with Crohn's disease. Treatment with omeprazole led to prompt relief of symptoms and complete healing of ulceration, which was confirmed by endoscopy. Omeprazole is effective in resistant peptic ulceration,' but there is only one report of its use in Crohn's disease.4 A proton pump inhibitor, it is capable of maintaining high intragastric pH for long periods. Its effectiveness in our two patients suggests that duodenal ulceration in Crohn's disease is dependent on acid. If prolonged active ulceration can cause pyloric stenosis then intermittent omeprazole treatment might prevent this complication in patients with Crohn's disease. Our observations support the view that inhibition of acid production is more likely to heal duodenal ulceration associated with Crohn's disease than steroid treatment, which may lead to complications such as perforation or haemorrhage.

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