Critical review of the main provisions of the IV Roman Consensus on central mediated gastrointestinal disorders. It is shown that the doctrine of a central mediated gastrointestinal pain disorder has undergone a significant change after the publication of the IV Roman Consensus. Causative factors of the insolvency of the regulatory relationships of the axis “brain-gastrointestinal tract” are combined morphological and physiological abnormalities associated with violations of motility of the gastrointestinal tract, mucous barrier, immune function, intestinal microbiota, visceral hypersensitivity, as well as CNS disorders. All this served as an excuse for excluding from the name of a number of disorders described by the Roman consensus the words “functional”. Also, the diagnosis of “functional abdominal pain syndrome” was changed to the syndrome of centrally induced abdominal pain (SCIAB), which is more appropriate for the pathogenesis of this disorder and reflects current information on the interaction of the gastrointestinal tract and the central nervous system. The isolation of narcotic intestinal syndrome (NIS) into a separate functional disorder, at first glance, seems illogical, since this pathology is induced by a known etiologic factor. On the other hand, the use of opioids alters the interaction between the CNS and the enteral nervous system, which may be accompanied by the development of NIS. Thus, the definition of NIS within the framework of functional pathology does not contradict the main provisions of the IV Roman Consensus of 2016.