# Rome IV E1 biliary pain Rome IV biliary pain Status: LIVE Price: $0.005 USDC `GET /api/calc/rome_iv_biliary_pain` HTML: https://magentlab.com/docs/rome-iv-biliary-pain Markdown: https://magentlab.com/docs/rome-iv-biliary-pain.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Apply the Cotton 2016 Rome IV E1 diagnostic criteria for biliary pain and return whether the published biliary-pain box holds (rome_iv_biliary_pain) plus three supportive flags. ## When to use When an agent already has the nine caller-assigned Cotton 2016 Rome IV E1 biliary-pain flags and needs whether the published biliary-pain box holds. magent does not examine the patient or read ultrasound, HIDA, or ERCP. ## When not to use - Not a medical device. - Not a diagnosis. magent does not diagnose biliary pain or biliary disease. - The caller assigns the nine flags. magent does not examine the patient or read ultrasound, HIDA, or ERCP. - This tool is Cotton 2016 Rome IV E1 biliary pain only. nausea_and_vomiting, radiation_to_back_or_right_infra_subscapular, and waking_from_sleep are supportive and not required. Not functional gallbladder disorder. Not biliary sphincter of Oddi disorder. Not pancreatic sphincter of Oddi disorder. ## Formula ``` rome_iv_biliary_pain iff epigastric_or_ruq_pain and builds_to_steady_level_lasts_30_min_or_longer and occurring_at_different_intervals_not_daily and severe_enough_to_interrupt_activities_or_ed_visit and not_significantly_related_to_bowel_movements and not_significantly_relieved_by_postural_change_or_acid_suppression (Cotton 2016 Rome IV E1 biliary pain). Supportive nausea_and_vomiting, radiation_to_back_or_right_infra_subscapular, waking_from_sleep are reported and not required. ``` ## Citation [Gallbladder and Sphincter of Oddi Disorders](https://doi.org/10.1053/j.gastro.2016.02.033) Cotton PB, Elta GH, Carter CR, Pasricha PJ, Corazziari ES Gastroenterology. 2016;150(6):1420-1429 DOI: [10.1053/j.gastro.2016.02.033](https://doi.org/10.1053/j.gastro.2016.02.033) ## Worked example ### Six required flags and three supportive flags Given: `builds_to_steady_level_lasts_30_min_or_longer=true, epigastric_or_ruq_pain=true, nausea_and_vomiting=true, not_significantly_related_to_bowel_movements=true, not_significantly_relieved_by_postural_change_or_acid_suppression=true, occurring_at_different_intervals_not_daily=true, radiation_to_back_or_right_infra_subscapular=true, severe_enough_to_interrupt_activities_or_ed_visit=true, waking_from_sleep=true` 1. Pain located in the epigastrium and/or right upper quadrant is true 2. Pain builds to a steady level lasting 30 minutes or longer is true 3. Pain occurring at different intervals (not daily) is true 4. Pain severe enough to interrupt daily activities or lead to an ED visit is true 5. Pain not significantly related to bowel movements is true 6. Pain not significantly relieved by postural change or acid suppression is true 7. Nausea and vomiting, radiation to the back or right infra subscapular region, and waking from sleep are true (supportive, not required) 8. rome_iv_biliary_pain is true ### Six required flags without supportive flags Given: `builds_to_steady_level_lasts_30_min_or_longer=true, epigastric_or_ruq_pain=true, nausea_and_vomiting=false, not_significantly_related_to_bowel_movements=true, not_significantly_relieved_by_postural_change_or_acid_suppression=true, occurring_at_different_intervals_not_daily=true, radiation_to_back_or_right_infra_subscapular=false, severe_enough_to_interrupt_activities_or_ed_visit=true, waking_from_sleep=false` 1. All six required E1 flags hold 2. All three supportive flags are false 3. rome_iv_biliary_pain is true because supportive flags are reported and not required ## Also searched as - Rome IV biliary pain - Cotton 2016 biliary pain - Rome IV E1 biliary pain - biliary pain diagnostic criteria - epigastric right upper quadrant pain - gallbladder pain Rome IV - Rome IV gallbladder biliary pain - Cotton gallbladder sphincter of Oddi ## Parameters - `epigastric_or_ruq_pain` (boolean, required): Pain located in the epigastrium and/or right upper quadrant (Cotton 2016 Rome IV E1 biliary pain). true or false as assigned by the caller. magent does not examine the patient. - `builds_to_steady_level_lasts_30_min_or_longer` (boolean, required): Pain builds up to a steady level and lasts 30 minutes or longer, as assigned (Cotton 2016). true or false as assigned by the caller. magent does not take a history. - `occurring_at_different_intervals_not_daily` (boolean, required): Pain occurring at different intervals (not daily), as assigned (Cotton 2016). true or false as assigned by the caller. magent does not take a history. - `severe_enough_to_interrupt_activities_or_ed_visit` (boolean, required): Pain severe enough to interrupt daily activities or lead to an emergency department visit, as assigned (Cotton 2016). true or false as assigned by the caller. magent does not take a history. - `not_significantly_related_to_bowel_movements` (boolean, required): Pain not significantly (<20%) related to bowel movements, as assigned (Cotton 2016). true or false as assigned by the caller. magent does not take a history. - `not_significantly_relieved_by_postural_change_or_acid_suppression` (boolean, required): Pain not significantly (<20%) relieved by postural change or acid suppression, as assigned (Cotton 2016). true or false as assigned by the caller. magent does not take a history. - `nausea_and_vomiting` (boolean, required): Pain may be associated with nausea and vomiting, a supportive criterion that is not required for rome_iv_biliary_pain (Cotton 2016). true or false as assigned by the caller. magent does not take a history. - `radiation_to_back_or_right_infra_subscapular` (boolean, required): Pain may radiate to the back and/or right infra subscapular region, a supportive criterion that is not required for rome_iv_biliary_pain (Cotton 2016). true or false as assigned by the caller. magent does not examine the patient. - `waking_from_sleep` (boolean, required): Pain may wake the patient from sleep, a supportive criterion that is not required for rome_iv_biliary_pain (Cotton 2016). true or false as assigned by the caller. magent does not take a history. ## Bulk (POST) POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement. Method: `POST /api/calc/rome_iv_biliary_pain` Max items: 25 Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic) Status: PREVIEW - 1 to 25 items. Each item uses the same keys as the GET query parameters. - POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows. - The first invalid item fails the whole request (index in the 400 JSON). You are not charged. - HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row. - Catalog misses (empty matches, found=false) stay paid 200s inside that slot. - x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items. Example request: ```json { "items": [ { "builds_to_steady_level_lasts_30_min_or_longer": "true", "epigastric_or_ruq_pain": "true", "nausea_and_vomiting": "true", "not_significantly_related_to_bowel_movements": "true", "not_significantly_relieved_by_postural_change_or_acid_suppression": "true", "occurring_at_different_intervals_not_daily": "true", "radiation_to_back_or_right_infra_subscapular": "true", "severe_enough_to_interrupt_activities_or_ed_visit": "true", "waking_from_sleep": "true" }, { "builds_to_steady_level_lasts_30_min_or_longer": "true", "epigastric_or_ruq_pain": "true", "nausea_and_vomiting": "true", "not_significantly_related_to_bowel_movements": "true", "not_significantly_relieved_by_postural_change_or_acid_suppression": "true", "occurring_at_different_intervals_not_daily": "true", "radiation_to_back_or_right_infra_subscapular": "true", "severe_enough_to_interrupt_activities_or_ed_visit": "true", "waking_from_sleep": "true" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/rome-iv-biliary-pain Example 200: ```json { "count": 2, "path": "/api/calc/rome_iv_biliary_pain", "items": [ { "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Cotton PB, Elta GH, Carter CR, Pasricha PJ, Corazziari ES", "doi": "10.1053/j.gastro.2016.02.033", "id": "cotton-2016", "pmid": "27144629", "source": "Gastroenterology. 2016;150(6):1420-1429", "title": "Gallbladder and Sphincter of Oddi Disorders" }, "formula": "rome_iv_biliary_pain", "formula_expression": "rome_iv_biliary_pain iff epigastric_or_ruq_pain and builds_to_steady_level_lasts_30_min_or_longer and occurring_at_different_intervals_not_daily and severe_enough_to_interrupt_activities_or_ed_visit and not_significantly_related_to_bowel_movements and not_significantly_relieved_by_postural_change_or_acid_suppression (Cotton 2016 Rome IV E1 biliary pain). Supportive nausea_and_vomiting, radiation_to_back_or_right_infra_subscapular, waking_from_sleep are reported and not required.", "criteria": [ { "factor": "epigastric_or_ruq_pain", "met": true }, { "factor": "builds_to_steady_level_lasts_30_min_or_longer", "met": true }, { "factor": "occurring_at_different_intervals_not_daily", "met": true }, { "factor": "severe_enough_to_interrupt_activities_or_ed_visit", "met": true }, { "factor": "not_significantly_related_to_bowel_movements", "met": true }, { "factor": "not_significantly_relieved_by_postural_change_or_acid_suppression", "met": true }, { "factor": "nausea_and_vomiting", "met": true }, { "factor": "radiation_to_back_or_right_infra_subscapular", "met": true }, { "factor": "waking_from_sleep", "met": true } ], "nausea_and_vomiting": true, "radiation_to_back_or_right_infra_subscapular": true, "rome_iv_biliary_pain": true, "waking_from_sleep": true }, { "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Cotton PB, Elta GH, Carter CR, Pasricha PJ, Corazziari ES", "doi": "10.1053/j.gastro.2016.02.033", "id": "cotton-2016", "pmid": "27144629", "source": "Gastroenterology. 2016;150(6):1420-1429", "title": "Gallbladder and Sphincter of Oddi Disorders" }, "formula": "rome_iv_biliary_pain", "formula_expression": "rome_iv_biliary_pain iff epigastric_or_ruq_pain and builds_to_steady_level_lasts_30_min_or_longer and occurring_at_different_intervals_not_daily and severe_enough_to_interrupt_activities_or_ed_visit and not_significantly_related_to_bowel_movements and not_significantly_relieved_by_postural_change_or_acid_suppression (Cotton 2016 Rome IV E1 biliary pain). Supportive nausea_and_vomiting, radiation_to_back_or_right_infra_subscapular, waking_from_sleep are reported and not required.", "criteria": [ { "factor": "epigastric_or_ruq_pain", "met": true }, { "factor": "builds_to_steady_level_lasts_30_min_or_longer", "met": true }, { "factor": "occurring_at_different_intervals_not_daily", "met": true }, { "factor": "severe_enough_to_interrupt_activities_or_ed_visit", "met": true }, { "factor": "not_significantly_related_to_bowel_movements", "met": true }, { "factor": "not_significantly_relieved_by_postural_change_or_acid_suppression", "met": true }, { "factor": "nausea_and_vomiting", "met": true }, { "factor": "radiation_to_back_or_right_infra_subscapular", "met": true }, { "factor": "waking_from_sleep", "met": true } ], "nausea_and_vomiting": true, "radiation_to_back_or_right_infra_subscapular": true, "rome_iv_biliary_pain": true, "waking_from_sleep": true } ] } ``` ## Response fields - `formula` (string): rome_iv_biliary_pain - `formula_expression` (string): Cotton 2016 Rome IV E1 biliary pain: epigastric or RUQ pain that builds to a steady level lasting 30 minutes or longer, occurs at different intervals (not daily), is severe enough to interrupt daily activities or lead to an ED visit, is not significantly related to bowel movements, and is not significantly relieved by postural change or acid suppression; nausea_and_vomiting, radiation_to_back_or_right_infra_subscapular, and waking_from_sleep are supportive and not required - `nausea_and_vomiting` (boolean): Caller-assigned supportive nausea and vomiting flag. Reported separately; not required for rome_iv_biliary_pain. - `radiation_to_back_or_right_infra_subscapular` (boolean): Caller-assigned supportive radiation to the back and/or right infra subscapular region. Reported separately; not required for rome_iv_biliary_pain. - `waking_from_sleep` (boolean): Caller-assigned supportive waking from sleep flag. Reported separately; not required for rome_iv_biliary_pain. - `rome_iv_biliary_pain` (boolean): true only when all six required E1 flags hold. Supportive flags are not required. Not a diagnosis. - `criteria` (array): Per-factor rows with factor and met for the six required E1 flags plus three supportive flags - `citation` (object): Cotton 2016 Gastroenterology citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Cotton PB, Elta GH, Carter CR, Pasricha PJ, Corazziari ES", "doi": "10.1053/j.gastro.2016.02.033", "id": "cotton-2016", "pmid": "27144629", "source": "Gastroenterology. 2016;150(6):1420-1429", "title": "Gallbladder and Sphincter of Oddi Disorders" }, "formula": "rome_iv_biliary_pain", "formula_expression": "rome_iv_biliary_pain iff epigastric_or_ruq_pain and builds_to_steady_level_lasts_30_min_or_longer and occurring_at_different_intervals_not_daily and severe_enough_to_interrupt_activities_or_ed_visit and not_significantly_related_to_bowel_movements and not_significantly_relieved_by_postural_change_or_acid_suppression (Cotton 2016 Rome IV E1 biliary pain). Supportive nausea_and_vomiting, radiation_to_back_or_right_infra_subscapular, waking_from_sleep are reported and not required.", "criteria": [ { "factor": "epigastric_or_ruq_pain", "met": true }, { "factor": "builds_to_steady_level_lasts_30_min_or_longer", "met": true }, { "factor": "occurring_at_different_intervals_not_daily", "met": true }, { "factor": "severe_enough_to_interrupt_activities_or_ed_visit", "met": true }, { "factor": "not_significantly_related_to_bowel_movements", "met": true }, { "factor": "not_significantly_relieved_by_postural_change_or_acid_suppression", "met": true }, { "factor": "nausea_and_vomiting", "met": true }, { "factor": "radiation_to_back_or_right_infra_subscapular", "met": true }, { "factor": "waking_from_sleep", "met": true } ], "nausea_and_vomiting": true, "radiation_to_back_or_right_infra_subscapular": true, "rome_iv_biliary_pain": true, "waking_from_sleep": true } ``` ## Errors - HTTP 400 `invalid_rome_iv_biliary_pain`: Rome IV biliary pain needs the Cotton 2016 gallbladder and sphincter-of-Oddi pain flags. Returned before settlement; you are not charged. - HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - [Rome IV FGBD](https://magentlab.com/docs/rome-iv-functional-gallbladder) — Apply the Cotton 2016 Rome IV E1a functional gallbladder disorder diagnostic criteria and return whether the published E1a box holds (rome_iv_functional_gallbladder) plus the two supportive flags. - [Rome IV biliary SOD](https://magentlab.com/docs/rome-iv-biliary-sod) — Apply the Cotton 2016 Rome IV E1b functional biliary sphincter of Oddi disorder diagnostic criteria and return whether the published E1b box holds (rome_iv_biliary_sod). Elevated liver enzymes XOR dilated bile duct is required. Supportive flags are reported and not required. ## Payment Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional. - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/docs/mcp ## Guarantees - HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON. - exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE. - HTTP 402 is unpaid only. Do not sign a second authorization because of a 503. - Execution is timeout-bounded and concurrency-capped. - Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.