Rome V Criteria (2026): Continuity, innovations and major updates

In 2026, the fifth revision of the Rome criteria (Rome V) was published, reflecting the current concept of disorders of gut–brain interaction (DGBI) as an independent group of diseases associated with impaired visceral sensitivity, dysregulation of the gut-brain axis, and immune-inflammatory and psychophysiological mechanisms. The relevance of this review is determined by the high prevalence of DGBI, their frequent overlap, their substantial impact on patients’ quality of life, and the need to adapt new international diagnostic approaches to routine gastroenterological practice. The particular importance of Rome V is associated with the transition from a predominantly symptom-oriented description of functional disorders to a clinical and instrumental diagnostic model based on the combination of symptom criteria, criteria for excluding organic pathology, and modern instrumental standards. Publications were excluded if the full text was unavailable, if they were not relevant to DGBI, if they duplicated previously published data, or if their findings could not be correlated with current diagnostic criteria. The Lyon Consensus 2.0 and the Chicago Classification v4.0 are now considered essential components in the diagnosis of functional esophageal disorders. Functional impedance planimetry significantly improves the diagnostic specificity for functional dysphagia. In irritable bowel syndrome (IBS), the symptom of “discomfort” and a lower symptom-frequency threshold have been reinstated, which is expected to improve case identification in populations where pain is perceived or reported less intensely. Retrograde cricopharyngeal dysfunction (R-CPD), commonly referred to as the inability-to-burp syndrome, has been recognized as a distinct clinical entity with specific diagnostic and therapeutic criteria.