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    Rome IV Diagnostic Criteria for Irritable Bowel Syndrome (IBS)

    Provides criteria for diagnosis of irritable bowel syndrome.
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    INSTRUCTIONS

    Use in patients with recurrent abdominal pain at least 1 day per week in the last 3 months on average, associated with ≥2 of the criteria below. The criteria are fulfilled with symptoms onset 6 months prior to diagnosis.

    When to Use
    Pearls/Pitfalls

    Patients being evaluated for possible IBS.

    How Rome IV has changed from Rome III:

    • Intended to be applied to a more multicultural population than Rome III, which was derived for a Western cohort.
    • Requires only pain as a symptom (“discomfort” has been eliminated because it is nonspecific). Pain can either increase or decrease with bowel movements, versus decreasing only in Rome III.
    • Includes criteria for subtypes of IBS.

    Point to keep in mind:

    • There remains no objective reference (i.e., “gold”) standard for IBS; the criteria were developed through a literature review and consensus process.
    Must have ≥2 of the following:

    Associated with recurrent abdominal pain ≥1 day/wk in the last 3 months (on average)

    Diagnostic Result:

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    Next Steps
    Evidence
    Creator Insights

    Management

    Differences between Rome III and Rome IV:

    Differences between Rome IV and Rome III Criteria for IBS

    Drossman 2017.

     

    Formula

    Recurrent abdominal pain at least 1 day per week in the last 3 months on average, associated with ≥2 of the criteria* below:

    Related to defecation (either increasing or improving pain)

    Associated with a change in stool frequency

    Associated with a change in stool form (appearance)

    *The criteria are fulfilled with symptoms onset 6 months prior to diagnosis.

    Subtypes:

    IBS-C

    >25% of bowel movements with Bristol Stool Scale Types 1–2 and <25% with Types 6–7.

    IBS-D

    >25% of bowel movements with Bristol Stool Scale Types 6–7 and <25% with Types 1–2.

    IBS-M

    >25%of bowel movements with Bristol Stool Scale Types 1–2 and >25% with Types 6–7.

    IBS-U

    Meets diagnostic criteria for IBS but bowel habits not accurately categorized in any of the above subtypes.

    IBS, irritable bowel syndrome; IBS-C, IBS with predominant constipation; IBS-D, IBS with predominant diarrhea; IBS-M, IBS with mixed bowel habits; IBS-U, unclassified IBS.

    Bristol Stool Scale:

    From Chumpitazi 2016.

    Dr. Douglas Drossman

    About the Creator

    Douglas Drossman, MD, is professor emeritus of medicine and psychiatry at the University of North Carolina School of Medicine. He is also the founder of the Drossman Center for the Education and Practice of Biopsychosocial Care and Drossman Consulting, LLC. Dr. Drossman has written over 500 articles and book chapters, has published two books, a GI procedure manual and a textbook of functional GI disorders (Rome I-IV), and serves on six editorial and advisory boards.

    To view Dr. Douglas Drossman's publications, visit PubMed

    About the Creator
    Dr. Douglas Drossman