# Rome IV functional gallbladder disorder Rome IV FGBD Status: LIVE Price: $0.005 USDC `GET /api/calc/rome_iv_functional_gallbladder` HTML: https://magentlab.com/docs/rome-iv-functional-gallbladder Markdown: https://magentlab.com/docs/rome-iv-functional-gallbladder.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes 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. ## When to use When an agent already has the nine caller-assigned Cotton 2016 Rome IV E1a flags and needs whether the published functional gallbladder box holds. magent does not read ultrasound, EUS, or HIDA or decide cholecystectomy. ## When not to use - Not a medical device. - Not a diagnosis. magent does not diagnose functional gallbladder disorder. - The caller assigns the nine flags. magent does not read ultrasound, EUS, or HIDA scintigraphy, and does not decide cholecystectomy. - This tool is Cotton 2016 Rome IV E1a functional gallbladder disorder only. Nested E1 biliary pain and absence of gallstones or other structural pathology are required. Low ejection fraction on gallbladder scintigraphy (GBEF) is supportive only and is not required. Normal liver enzymes, conjugated bilirubin, and amylase/lipase are supportive and not required. Not biliary SOD (E1b). Not pancreatic SOD (E2). ## Formula ``` rome_iv_functional_gallbladder 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 and absence_of_gallstones_or_other_structural_pathology (Cotton 2016 Rome IV E1a). low_ef_on_gallbladder_scintigraphy and normal_liver_enzymes_conjugated_bilirubin_amylase_lipase are supportive 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 ### Seven required flags and both supportive flags Given: `absence_of_gallstones_or_other_structural_pathology=true, builds_to_steady_level_lasts_30_min_or_longer=true, epigastric_or_ruq_pain=true, low_ef_on_gallbladder_scintigraphy=true, normal_liver_enzymes_conjugated_bilirubin_amylase_lipase=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, severe_enough_to_interrupt_activities_or_ed_visit=true` 1. Epigastric or RUQ pain 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 activities or prompt an ED visit is true 5. Pain is not significantly related to bowel movements 6. Pain is not significantly relieved by postural change or acid suppression 7. Absence of gallstones or other structural pathology is true 8. Low ejection fraction on gallbladder scintigraphy is true (supportive, not required) 9. Normal liver enzymes, conjugated bilirubin, and amylase/lipase is true (supportive, not required) 10. rome_iv_functional_gallbladder is true ### Seven required flags without supportive flags Given: `absence_of_gallstones_or_other_structural_pathology=true, builds_to_steady_level_lasts_30_min_or_longer=true, epigastric_or_ruq_pain=true, low_ef_on_gallbladder_scintigraphy=false, normal_liver_enzymes_conjugated_bilirubin_amylase_lipase=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, severe_enough_to_interrupt_activities_or_ed_visit=true` 1. All seven required flags hold 2. Low ejection fraction on gallbladder scintigraphy is false 3. Normal liver enzymes, conjugated bilirubin, and amylase/lipase is false 4. rome_iv_functional_gallbladder is true because the two supportive flags are not required ## Also searched as - Rome IV functional gallbladder - Rome IV E1a - Cotton 2016 functional gallbladder - functional gallbladder disorder - biliary dyskinesia Rome IV - acalculous biliary pain - low GBEF HIDA - Rome IV gallbladder criteria ## Parameters - `epigastric_or_ruq_pain` (boolean, required): Epigastric or right upper quadrant pain, as assigned (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 to a steady level and lasts 30 minutes or longer, as assigned (Cotton 2016 E1). 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 E1). 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 usual activities or lead to an emergency department visit, as assigned (Cotton 2016 E1). 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 related to bowel movements, as assigned (Cotton 2016 E1). 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 relieved by postural change or acid suppression, as assigned (Cotton 2016 E1). true or false as assigned by the caller. magent does not take a history. - `absence_of_gallstones_or_other_structural_pathology` (boolean, required): Absence of gallstones or other structural pathology, as assigned (Cotton 2016 Rome IV E1a). true or false as assigned by the caller. magent does not read ultrasound, EUS, or other imaging. - `low_ef_on_gallbladder_scintigraphy` (boolean, required): Low ejection fraction on gallbladder scintigraphy, a supportive criterion that is not required for rome_iv_functional_gallbladder (Cotton 2016). true or false as assigned by the caller. magent does not read HIDA or decide cholecystectomy. - `normal_liver_enzymes_conjugated_bilirubin_amylase_lipase` (boolean, required): Normal liver enzymes, conjugated bilirubin, and amylase/lipase, a supportive criterion that is not required for rome_iv_functional_gallbladder (Cotton 2016). true or false as assigned by the caller. magent does not read laboratory results. ## 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_functional_gallbladder` 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": [ { "absence_of_gallstones_or_other_structural_pathology": "true", "builds_to_steady_level_lasts_30_min_or_longer": "true", "epigastric_or_ruq_pain": "true", "low_ef_on_gallbladder_scintigraphy": "true", "normal_liver_enzymes_conjugated_bilirubin_amylase_lipase": "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", "severe_enough_to_interrupt_activities_or_ed_visit": "true" }, { "absence_of_gallstones_or_other_structural_pathology": "true", "builds_to_steady_level_lasts_30_min_or_longer": "true", "epigastric_or_ruq_pain": "true", "low_ef_on_gallbladder_scintigraphy": "true", "normal_liver_enzymes_conjugated_bilirubin_amylase_lipase": "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", "severe_enough_to_interrupt_activities_or_ed_visit": "true" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/rome-iv-functional-gallbladder Example 200: ```json { "count": 2, "path": "/api/calc/rome_iv_functional_gallbladder", "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_functional_gallbladder", "formula_expression": "rome_iv_functional_gallbladder 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 and absence_of_gallstones_or_other_structural_pathology (Cotton 2016 Rome IV E1a). low_ef_on_gallbladder_scintigraphy and normal_liver_enzymes_conjugated_bilirubin_amylase_lipase are supportive 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": "absence_of_gallstones_or_other_structural_pathology", "met": true }, { "factor": "low_ef_on_gallbladder_scintigraphy", "met": true }, { "factor": "normal_liver_enzymes_conjugated_bilirubin_amylase_lipase", "met": true } ], "low_ef_on_gallbladder_scintigraphy": true, "normal_liver_enzymes_conjugated_bilirubin_amylase_lipase": true, "rome_iv_functional_gallbladder": 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_functional_gallbladder", "formula_expression": "rome_iv_functional_gallbladder 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 and absence_of_gallstones_or_other_structural_pathology (Cotton 2016 Rome IV E1a). low_ef_on_gallbladder_scintigraphy and normal_liver_enzymes_conjugated_bilirubin_amylase_lipase are supportive 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": "absence_of_gallstones_or_other_structural_pathology", "met": true }, { "factor": "low_ef_on_gallbladder_scintigraphy", "met": true }, { "factor": "normal_liver_enzymes_conjugated_bilirubin_amylase_lipase", "met": true } ], "low_ef_on_gallbladder_scintigraphy": true, "normal_liver_enzymes_conjugated_bilirubin_amylase_lipase": true, "rome_iv_functional_gallbladder": true } ] } ``` ## Response fields - `formula` (string): rome_iv_functional_gallbladder - `formula_expression` (string): Cotton 2016 Rome IV E1a: nested E1 biliary pain plus absence of gallstones or other structural pathology; low_ef_on_gallbladder_scintigraphy and normal_liver_enzymes_conjugated_bilirubin_amylase_lipase are supportive and not required - `low_ef_on_gallbladder_scintigraphy` (boolean): Caller-assigned supportive low gallbladder ejection fraction on scintigraphy. Reported separately; not required for rome_iv_functional_gallbladder. - `normal_liver_enzymes_conjugated_bilirubin_amylase_lipase` (boolean): Caller-assigned supportive normal liver enzymes, conjugated bilirubin, and amylase/lipase. Reported separately; not required for rome_iv_functional_gallbladder. - `rome_iv_functional_gallbladder` (boolean): true only when all seven required flags hold. Supportive scintigraphy and enzyme flags are not required. Not a diagnosis. - `criteria` (array): Per-factor rows with factor and met for the seven required flags plus two 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_functional_gallbladder", "formula_expression": "rome_iv_functional_gallbladder 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 and absence_of_gallstones_or_other_structural_pathology (Cotton 2016 Rome IV E1a). low_ef_on_gallbladder_scintigraphy and normal_liver_enzymes_conjugated_bilirubin_amylase_lipase are supportive 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": "absence_of_gallstones_or_other_structural_pathology", "met": true }, { "factor": "low_ef_on_gallbladder_scintigraphy", "met": true }, { "factor": "normal_liver_enzymes_conjugated_bilirubin_amylase_lipase", "met": true } ], "low_ef_on_gallbladder_scintigraphy": true, "normal_liver_enzymes_conjugated_bilirubin_amylase_lipase": true, "rome_iv_functional_gallbladder": true } ``` ## Errors - HTTP 400 `invalid_rome_iv_functional_gallbladder`: Rome IV functional gallbladder needs the Cotton 2016 E1a biliary-pain and structural-exclusion 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 biliary pain](https://magentlab.com/docs/rome-iv-biliary-pain) — 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. - [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.