Rome IV Diagnostic Criteria for Nausea and Vomiting Disorders

Nausea is a subjective symptom and can be defined as an unpleasant sensation of the imminent need to vomit, typically experienced in the epigastrium or throat. Vomiting refers to the forceful oral expulsion of gastrointestinal contents associated with contraction of the abdominal and chest wall muscles.

Diagnostic criteria for Chronic Nausea Vomiting Syndrome (CNVS)
Must include all of the following:

1. Bothersome (i.e., severe enough to impact on usual activities) nausea, occurring at least 1 day per week and/or one or more vomiting episodes per week
2. Self-induced vomiting, eating disorders, regurgitation, or rumination are excluded
3. No evidence of organic, systemic, or metabolic diseases likely to explain the symptoms on routine investigations (including at upper endoscopy)

*Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis

Diagnostic criteria for Cyclic Vomiting Syndrome (CVS)
Must include all of the following:

Stereotypical episodes of vomiting regarding onset (acute) and duration (less than 1 week)

1. At least three discrete episodes in the prior year and two episodes in the past 6 months, occurring at least 1 week apart
2. Absence of vomiting between episodes, but other milder symptoms can be present between cycles

*Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis

Supportive remark

• History or family history of migraine headaches

Diagnostic criteria for Cannabinoid Hyperemesis Syndrome (CHS)
Must include all of the following:

1. Stereotypical episodic vomiting resembling cyclic vomiting syndrome (CVS) in terms of onset, duration, and frequency
2. Presentation after prolonged use of cannabis
3. Relief of vomiting episodes by sustained cessation of cannabis use

*Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis

Supportive remark

• May be associated with pathologic bathing behavior (prolonged hot baths or showers)

 

References:

1. Stanghellini V, Chan FK, Hasler WL, Malagelada JR, Suzuki H, Tack J, Talley NJ. Gastroduodenal Disorders. Gastroenterology. 2016 May;150(6):1380-92. [Medline]
2. Schmulson MJ, Drossman DA. What Is New in Rome IV. J Neurogastroenterol Motil. 2017 Apr 30;23(2):151-163. [Medline]
3. Baaleman DF, Di Lorenzo C, Benninga MA, Saps M. The Effects of the Rome IV Criteria on Pediatric Gastrointestinal Practice. Curr Gastroenterol Rep. 2020 Mar 19;22(5):21. [Medline]

 

Created Aug 24, 2021.