What is the updated Rome IV criteria for diagnosis of irritable bowel syndrome (IBS)?

Updated: Dec 11, 2019
  • Author: Jenifer K Lehrer, MD; Chief Editor: BS Anand, MD  more...
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Answer

A consensus panel created and continually updates the Rome diagnostic criteria to provide a standardized diagnosis for research and clinical practice. The Rome IV criteria for the diagnosis of irritable bowel syndrome (IBS) were released in 2016 and require that patients have had recurrent abdominal pain on average at least 1 day per week during the previous 3 months that is associated with two or more of the following [2] :

  • Related to defecation (may be increased or unchanged by defecation)

  • Associated with a change in stool frequency

  • Associated with a change in stool form or appearance

Unlike the Rome III criteria, the Rome IV criteria only require abdominal pain in defining this condition; "discomfort" is no longer included owing to its ambiguity and different meanings across cultures and languages. [2]

Supporting symptoms include the following:

  • Altered stool frequency

  • Altered stool form

  • Altered stool passage (straining and/or urgency)

  • Mucorrhea

  • Abdominal bloating or subjective distention

Four bowel patterns may be seen with irritable bowel syndrome, and these remain unchanged in the Rome IV classification. [2] These patterns include the following:

  • IBS-D (diarrhea predominant)

  • IBS-C (constipation predominant)

  • IBS-M (mixed diarrhea and constipation)

  • IBS-U (unclassified; the symptoms cannot be categorized into one of the above three subtypes)

The usefulness of these subtypes is debatable. Notably, within 1 year, 75% of patients change subtypes, and 29% switch between constipation-predominant IBS and diarrhea-predominant IBS. The Rome IV criteria differ from the Rome III criteria in basing bowel habits on stool forms solely during days with abnormal bowel movements rather than on the total number of bowel movements. [2]


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