The Road from Rome V to the Pediatric Clinic: New Perspectives in 2026.

Rome V marks a paradigm shift in pediatric disorders of gut-brain interaction (DGBI). The new Rome V criteria introduced new, updated, and refined definitions for pediatric DGBI. A central feature of this framework is the shift toward anchoring diagnoses more firmly in pathophysiology and anatomic regions rather than age groups. Accordingly, the criteria are now organized into 2 major categories: upper gastrointestinal DGBI and lower gastrointestinal and biliary DGBI. Several new disorders have been added, including esophageal, feeding, and discomfort disorders, along with additional pain-related conditions. Existing criteria have been further refined, and emerging biomarkers are incorporated to support diagnoses. Finally, there is greater harmony between adult and pediatric diagnoses to support a seamless transition across the age continuum.