Global Prevalence of Functional Abdominal Pain Disorder among Children and Adolescents According to the Rome III and IV Criteria: A Systematic Review and Meta-Analysis

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: Rome III criteria: 11.84% (10.29-13.61%); Rome IV criteria: 8.42% (6.10-11.62%)

• Primary Outcome: Overall FAPD prevalence: 10.89% (95% CI: 9.51-12.48%)

• Nnt Or Sensitivity: Rome IV criteria demonstrate higher specificity with approximately 30% lower prevalence estimates compared to Rome III

• Confidence Interval: 95% confidence intervals provided for all estimates

Clinical Application

Rome IV criteria readily applicable in Australian practice with established diagnostic frameworks Relevant to RACGP guidelines for paediatric abdominal pain, supports PBS funding applications for functional GI disorders, aligns with Royal Children's Hospital clinical pathways Australian children and adolescents in primary care, paediatric gastroenterology, and community health settings

Abstract

BACKGROUND/AIMS: Despite the global burden of functional abdominal pain disorder (FAPD) and its four subtypes (irritable bowel syndrome [IBS], functional dyspepsia [FD], abdominal migraine [AM], and functional abdominal pain not otherwise specified [FAP-NOS]), studies involving an estimation of FAPD prevalence based on the Rome III or IV criteria are limited. Therefore, we aimed to estimate the prevalence of FAPD and its four subtypes. METHODS: A comprehensive literature search was conducted in PubMed/MEDLINE, Embase, Google Scholar, and the Cochrane Library. Studies that were performed with the general population and applied Rome III or IV diagnostic criteria were included. Data were extracted to estimate the prevalence of FAPD using a random-effects model with 95% confidence intervals (CIs). Heterogeneity was assessed using the I2 statistic. The study protocol was preregistered with PROSPERO (CRD420251004116). RESULTS: The overall prevalence of FAPD was 10.89% (95% CI, 9.51% to 12.48%), with pooled prevalence rates of 11.84% (10.29% to 13.61%) with the Rome III criteria and 8.42% (6.10% to 11.62%) with the Rome IV criteria. With the Rome III criteria, IBS had the highest prevalence, while FD had the lowest. In contrast, with the Rome IV criteria, the prevalence of IBS, AM, and FAP-NOS decreased, whereas FD became the most prevalent, affecting approximately one in 23 individuals, compared to one in 51 individuals affected by IBS, one in 68 individuals affected by AM, and one in 115 individuals affected by FAP-NOS. Additionally, females exhibited higher prevalence rates of FAPD and all its subtypes than males. CONCLUSIONS: The diagnostic criteria of Rome IV are stricter than those of Rome III, which likely affects the estimated prevalence of FAPD and its subtypes.

References

1. 1.Jeong, Y. D., Kim, S., Son, Y., Kim, T. H., Smith, L., Hajek, A., Kang, J., Hahn, J. W., & Yon, D. K. (2026). Global Prevalence of Functional Abdominal Pain Disorder among Children and Adolescents According to the Rome III and IV Criteria: A Systematic Review and Meta-Analysis. Gut and Liver. https://doi.org/10.5009/gnl250225