# Rome IV opioid-induced constipation Rome IV OIC Status: LIVE Price: $0.005 USDC `GET /api/calc/rome_iv_oic` HTML: https://magentlab.com/docs/rome-iv-oic Markdown: https://magentlab.com/docs/rome-iv-oic.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Apply the Mearin 2016 Rome IV C6 opioid-induced constipation criteria and return symptom_count (0-6) and whether the published C6 box holds (rome_iv_oic). ## When to use When an agent already has the eight caller-assigned Rome IV C6 flags as in Mearin 2016 and needs whether the published opioid-induced constipation box holds. magent does not examine the patient or prescribe opioids. ## When not to use - Not a medical device. - Not a diagnosis. magent does not diagnose opioid-induced constipation. - The caller assigns the eight flags. magent does not examine the patient. - This tool is adult Rome IV C6 opioid-induced constipation only. Not functional constipation C2 (rome-iv-fc is a different tool), not Rome IV IBS, and not child. magent does not prescribe opioids. ## Formula ``` rome_iv_oic iff new_or_worsening_constipation_on_opioid_change and symptom_count >= 2 and loose_stools_rare_without_laxatives; symptom_count counts straining_gt_25_percent, lumpy_or_hard_stools_gt_25_percent, incomplete_evacuation_gt_25_percent, anorectal_obstruction_gt_25_percent, manual_maneuvers_gt_25_percent, and fewer_than_3_sbm_per_week (Mearin 2016 Rome IV C6 opioid-induced constipation) ``` ## Citation [Bowel Disorders](https://doi.org/10.1053/j.gastro.2016.02.031) Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller RC Gastroenterology. 2016;150(6):1393-1407 DOI: [10.1053/j.gastro.2016.02.031](https://doi.org/10.1053/j.gastro.2016.02.031) ## Worked example ### Opioid change, two of six symptoms, and rare loose stools Given: `anorectal_obstruction_gt_25_percent=false, fewer_than_3_sbm_per_week=true, incomplete_evacuation_gt_25_percent=false, loose_stools_rare_without_laxatives=true, lumpy_or_hard_stools_gt_25_percent=false, manual_maneuvers_gt_25_percent=false, new_or_worsening_constipation_on_opioid_change=true, straining_gt_25_percent=true` 1. New or worsening constipation when initiating, changing, or increasing opioid therapy is true 2. Straining more than 25% of defecations and fewer than 3 spontaneous bowel movements per week are true; the other four symptom items are false (2 of 6) 3. Loose stools rarely present without laxatives is true 4. rome_iv_oic is true ### Opioid change and rare loose stools with only one symptom Given: `anorectal_obstruction_gt_25_percent=false, fewer_than_3_sbm_per_week=false, incomplete_evacuation_gt_25_percent=false, loose_stools_rare_without_laxatives=true, lumpy_or_hard_stools_gt_25_percent=false, manual_maneuvers_gt_25_percent=false, new_or_worsening_constipation_on_opioid_change=true, straining_gt_25_percent=true` 1. Opioid-change constipation and rare loose stools without laxatives hold 2. Only straining is true (1 of 6) 3. rome_iv_oic is false ## Also searched as - Rome IV opioid-induced constipation - Rome IV C6 - Mearin 2016 OIC - opioid-induced constipation criteria - Rome IV OIC - adult opioid-induced constipation - OIC Rome IV - Mearin C6 opioid constipation ## Parameters - `new_or_worsening_constipation_on_opioid_change` (boolean, required): New or worsening constipation when initiating, changing, or increasing opioid therapy, as assigned (Mearin 2016 C6). true or false as assigned by the caller. magent does not take a history or prescribe opioids. - `straining_gt_25_percent` (boolean, required): Straining during more than 25% of defecations (one of six C6 symptom items; at least two required). true or false as assigned by the caller. magent does not examine the patient. - `lumpy_or_hard_stools_gt_25_percent` (boolean, required): Lumpy or hard stools (Bristol stool form types 1-2) more than 25% of defecations (one of six C6 symptom items; at least two required). true or false as assigned by the caller. magent does not inspect stool. - `incomplete_evacuation_gt_25_percent` (boolean, required): Sensation of incomplete evacuation more than 25% of defecations (one of six C6 symptom items; at least two required). true or false as assigned by the caller. - `anorectal_obstruction_gt_25_percent` (boolean, required): Sensation of anorectal obstruction/blockage more than 25% of defecations (one of six C6 symptom items; at least two required). true or false as assigned by the caller. - `manual_maneuvers_gt_25_percent` (boolean, required): Manual maneuvers to facilitate more than 25% of defecations (one of six C6 symptom items; at least two required). true or false as assigned by the caller. - `fewer_than_3_sbm_per_week` (boolean, required): Fewer than three spontaneous bowel movements per week (one of six C6 symptom items; at least two required). true or false as assigned by the caller. - `loose_stools_rare_without_laxatives` (boolean, required): Loose stools are rarely present without the use of laxatives, as assigned (Mearin 2016 C6). true or false as assigned by the caller. magent does not examine the patient. ## 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_oic` 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": [ { "anorectal_obstruction_gt_25_percent": "false", "fewer_than_3_sbm_per_week": "true", "incomplete_evacuation_gt_25_percent": "false", "loose_stools_rare_without_laxatives": "true", "lumpy_or_hard_stools_gt_25_percent": "false", "manual_maneuvers_gt_25_percent": "false", "new_or_worsening_constipation_on_opioid_change": "true", "straining_gt_25_percent": "true" }, { "anorectal_obstruction_gt_25_percent": "false", "fewer_than_3_sbm_per_week": "true", "incomplete_evacuation_gt_25_percent": "false", "loose_stools_rare_without_laxatives": "true", "lumpy_or_hard_stools_gt_25_percent": "false", "manual_maneuvers_gt_25_percent": "false", "new_or_worsening_constipation_on_opioid_change": "true", "straining_gt_25_percent": "true" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/rome-iv-oic Example 200: ```json { "count": 2, "path": "/api/calc/rome_iv_oic", "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": "Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller RC", "doi": "10.1053/j.gastro.2016.02.031", "id": "mearin-2016", "pmid": "27144627", "source": "Gastroenterology. 2016;150(6):1393-1407", "title": "Bowel Disorders" }, "formula": "rome_iv_oic", "formula_expression": "rome_iv_oic iff new_or_worsening_constipation_on_opioid_change and symptom_count >= 2 and loose_stools_rare_without_laxatives; symptom_count counts straining_gt_25_percent, lumpy_or_hard_stools_gt_25_percent, incomplete_evacuation_gt_25_percent, anorectal_obstruction_gt_25_percent, manual_maneuvers_gt_25_percent, and fewer_than_3_sbm_per_week (Mearin 2016 Rome IV C6 opioid-induced constipation)", "criteria": [ { "factor": "new_or_worsening_constipation_on_opioid_change", "met": true }, { "factor": "straining_gt_25_percent", "met": true }, { "factor": "lumpy_or_hard_stools_gt_25_percent", "met": false }, { "factor": "incomplete_evacuation_gt_25_percent", "met": false }, { "factor": "anorectal_obstruction_gt_25_percent", "met": false }, { "factor": "manual_maneuvers_gt_25_percent", "met": false }, { "factor": "fewer_than_3_sbm_per_week", "met": true }, { "value": 2, "factor": "symptom_count_ge_2", "met": true }, { "factor": "loose_stools_rare_without_laxatives", "met": true } ], "symptom_count": 2, "rome_iv_oic": 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": "Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller RC", "doi": "10.1053/j.gastro.2016.02.031", "id": "mearin-2016", "pmid": "27144627", "source": "Gastroenterology. 2016;150(6):1393-1407", "title": "Bowel Disorders" }, "formula": "rome_iv_oic", "formula_expression": "rome_iv_oic iff new_or_worsening_constipation_on_opioid_change and symptom_count >= 2 and loose_stools_rare_without_laxatives; symptom_count counts straining_gt_25_percent, lumpy_or_hard_stools_gt_25_percent, incomplete_evacuation_gt_25_percent, anorectal_obstruction_gt_25_percent, manual_maneuvers_gt_25_percent, and fewer_than_3_sbm_per_week (Mearin 2016 Rome IV C6 opioid-induced constipation)", "criteria": [ { "factor": "new_or_worsening_constipation_on_opioid_change", "met": true }, { "factor": "straining_gt_25_percent", "met": true }, { "factor": "lumpy_or_hard_stools_gt_25_percent", "met": false }, { "factor": "incomplete_evacuation_gt_25_percent", "met": false }, { "factor": "anorectal_obstruction_gt_25_percent", "met": false }, { "factor": "manual_maneuvers_gt_25_percent", "met": false }, { "factor": "fewer_than_3_sbm_per_week", "met": true }, { "value": 2, "factor": "symptom_count_ge_2", "met": true }, { "factor": "loose_stools_rare_without_laxatives", "met": true } ], "symptom_count": 2, "rome_iv_oic": true } ] } ``` ## Response fields - `formula` (string): rome_iv_oic - `formula_expression` (string): Mearin 2016 Rome IV C6: new or worsening constipation on opioid change, at least 2 of 6 symptoms, and rare loose stools without laxatives - `symptom_count` (integer): Count of true C6 symptom items among straining, lumpy or hard stools, incomplete evacuation, anorectal obstruction, manual maneuvers, and fewer than 3 spontaneous bowel movements per week (0-6) - `rome_iv_oic` (boolean): true only when opioid-change constipation, at least two of six symptoms, and rare loose stools without laxatives all hold. Not a diagnosis. - `criteria` (array): Per-factor rows with factor and met; symptom_count_ge_2 includes value 0-6 - `citation` (object): Mearin 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": "Mearin F, Lacy BE, Chang L, Chey WD, Lembo AJ, Simren M, Spiller RC", "doi": "10.1053/j.gastro.2016.02.031", "id": "mearin-2016", "pmid": "27144627", "source": "Gastroenterology. 2016;150(6):1393-1407", "title": "Bowel Disorders" }, "formula": "rome_iv_oic", "formula_expression": "rome_iv_oic iff new_or_worsening_constipation_on_opioid_change and symptom_count >= 2 and loose_stools_rare_without_laxatives; symptom_count counts straining_gt_25_percent, lumpy_or_hard_stools_gt_25_percent, incomplete_evacuation_gt_25_percent, anorectal_obstruction_gt_25_percent, manual_maneuvers_gt_25_percent, and fewer_than_3_sbm_per_week (Mearin 2016 Rome IV C6 opioid-induced constipation)", "criteria": [ { "factor": "new_or_worsening_constipation_on_opioid_change", "met": true }, { "factor": "straining_gt_25_percent", "met": true }, { "factor": "lumpy_or_hard_stools_gt_25_percent", "met": false }, { "factor": "incomplete_evacuation_gt_25_percent", "met": false }, { "factor": "anorectal_obstruction_gt_25_percent", "met": false }, { "factor": "manual_maneuvers_gt_25_percent", "met": false }, { "factor": "fewer_than_3_sbm_per_week", "met": true }, { "value": 2, "factor": "symptom_count_ge_2", "met": true }, { "factor": "loose_stools_rare_without_laxatives", "met": true } ], "symptom_count": 2, "rome_iv_oic": true } ``` ## Errors - 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 FC](https://magentlab.com/docs/rome-iv-fc) — Apply the Mearin 2016 Rome IV C2 functional constipation criteria and return symptom_count (0-6) and whether the published C2 box holds (rome_iv_fc). - [Rome IV IBS](https://magentlab.com/docs/rome-iv-ibs) — Apply the Mearin 2016 Rome IV IBS diagnostic criteria and return supporting_features_met (0-3) and whether the published IBS box holds (rome_iv_ibs). - [Bristol stool](https://magentlab.com/docs/bristol-stool) — Return the Lewis 1997 Bristol stool form scale type 1-7 from a caller-assigned integer, with the published form wording. ## 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.