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    Rome IV Diagnostic Criteria for Irritable Bowel Syndrome (IBS)

    Official Rome IV criteria for the diagnosis of irritable bowel syndrome.

    INSTRUCTIONS

    Use in patients with symptoms suggestive of irritable bowel syndrome (IBS) such as chronic and recurrent abdominal pain and/or altered bowel habits for at least 6 months. 

    Patients with any of the following features must be evaluated clinically for other diagnoses even though IBS may be present:

    • Signs or symptoms of gastrointestinal bleeding.
    • Unexplained iron deficiency anemia.
    • Unintentional weight loss.
    • Palpable abdominal mass or lymphadenopathy on exam.
    • Family history of colon cancer and have not had age-appropriate colon cancer screening.
    • Onset of symptoms age ≥50 years and have not had age-appropriate colon cancer screening.
    • Sudden or acute onset of new change in bowel habit.
    When to Use
    Pearls/Pitfalls
    Why Use

    Patients presenting with symptoms suggestive of IBS for at least the past 6 months.  The diagnosis of IBS should be made by clinical history, physical examination, and minimal laboratory tests. Colonoscopy or other tests should be done if clinically indicated. Performing a battery of tests in all patients suspected of having IBS is not warranted.

    • The presence of chronic, recurrent abdominal pain at least 1 day per week is a requirement to make a diagnosis of IBS. This criteria was developed mainly to make a more precise diagnosis of IBS for clinical trials. 
    • Patients who don’t meet frequency criteria of abdominal pain at least 1 day per week may still be treated as IBS in clinical practice. 
    • If patients do not have abdominal pain but have altered bowel habits without a secondary cause, another diagnosis should be considered (e.g.  functional constipation, functional diarrhea, etc.). 
    • The IBS subtype is determined based on the presence of abnormal stools using the Bristol Stool Form Scale. Patients should not be using medications that could affect stool form.
    • For women, the abdominal pain should not exclusively occur during their menstrual period.

    • Used to establish a diagnosis of IBS in patients who present with abdominal pain and altered bowel habits.
    • Making a diagnosis will help guide the need for further work-up of symptoms and management.
    • Can be used to discuss the diagnosis of IBS with patients and institute treatment.
    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
    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

    Are you Dr. Douglas Drossman? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    Content Contributors
    • Colleen Parker, MD
    Reviewed By
    • Lin Chang, MD (Rome Foundation)
    About the Creator
    Dr. Douglas Drossman
    Are you Dr. Douglas Drossman?
    Content Contributors
    • Colleen Parker, MD
    Reviewed By
    • Lin Chang, MD (Rome Foundation)