Disorders of gut-brain interaction: discussing the new Rome V criteria. A review

Abstract

For a long time, gastrointestinal disorders in children remained a "gray area" in clinical medicine, as the term "functional disorder" created the impression that the problem was of secondary importance. However, in recent years, it has become evident that this term conceals a complex, multi-component pathology affecting not only the digestive system but also the central nervous system, immune status, and the child's emotional well-being. This understanding formed the basis for the new concept of disorders of gut-brain interaction (DGBI), officially established in the Rome V criteria published in 2026. The shift from functional disorders to disorders of interaction reflects a fundamental change in the scientific paradigm: the gut is viewed not as an isolated organ but as an active participant in bidirectional communication with the brain. This connection operates through various mechanisms ranging from the vagus nerve and neuroendocrine signals to the metabolic activity of the gut microbiota, which produces biologically active substances capable of influencing mood, behavior, and pain sensitivity. Understanding these mechanisms has opened up new avenues for diagnosis and therapy, shifting the focus from a symptomatic approach to a pathogenetic one. This review summarizes current data on the role of microbiota in the development of DGBI, examines comparative aspects of the Rome IV and Rome V classifications and diagnostic approaches, and discusses therapeutic strategies for DGBI, with a particular emphasis on evidence-based probiotic therapy.