Reviewed in Practical Gastroenterology, October 2000.

In 1988, a group of 30 internationally recognized investigators in functional gastrointestinal disorders took up the task of defining and categorization of 25 functional GI disorders from esophagus to anorectum. In 1994 they published the first edition of this book which included symptom-based ("Rome") diagnostic criteria for the functional GI disorders. Their hope that their effort will encourage the use of standardized diagnostic methods in the evaluation of functional GI diseases was amply realized. By using these criteria, an attempt is made to make a positive diagnosis of functional bowel disease thereby reducing the need for costly and unnecessary diagnostic studies, which are done to exclude organic disease.

Functional bowel problems constitute more than 50% of the gastrointestinal disorders seen by primary care physicians and gastroenterologists. As stated by W.G. Thompson regarding these disorders, "since there are no observed defects, we only know of the existence of these disorders through the words of our patients. Hence, there can be no animal models. Parrots may talk, but are not likely to discuss their bowels." However, some of the "functional" disorders do have objective manometric abnormalities e.g. sphincter of Oddio dysfunction, pelvic floor dyssynergia, etc. Regarding the animal model in the future, some veterinarians now specialize as dog psychiatrists and dog psychologists and treat depression and anxiety in dogs. Before long, dogs with diarrhea-dominant and constipation-dominant IBS may be identified

In 1978, Manning et al developed Rome I, IBS diagnostic criteria (Manning criteria). The senior editor of this second edition ("Rome" II) is D.A. Drossman who is well known in the field. This book is the result of the efforts of 100 international investigators and reviewers who are well known in the field of functional GI disorders. The material included has direct clinical applications. However, basic mechanisms of this disease are not ignored as attested to by the chapters on "Fundamentals of Neurogastroenterology: Basic Science." and "Principles of Applied Neurogastroenterology Physiology/Motility-Sensation." The addition of functional disorders in childhood has enhanced the value of this book.

Inclusion of chapters on design of treatment trials, definition of a responder in clinical trials in these disorders, research diagnostic and clinical diagnostic questionnaire in adult and pediatric functional GI disorders are welcome. A glossary of various terms used in these disorders has made this volume clinically more useful and the index appears to be comprehensive and user-friendly.

This is still an evolving field and organization of task forces for "Rome III" may already be in progress.

All in all this is a well-compiled volume on the subject and is full of clinically useful and relevant research material It is highly recommended and should be in the possession of every primary care physician and clinical gastroenterologist.

Nirmal S. Mann, M.D., Ph.D., D.Sc., FACP, FRCP, FACG
VA Medical Center
Temple, Texas