The Rome Criteria for IBS

This Group of Guidelines Can Help Diagnose IBS

Cramps keeping her chained to the bed
Part of the Rome Criteria for diagnosing IBS is that there are several days of pain and discomfort a month. Peopleimages / Getty Images

Irritable bowel syndrome (IBS) is largely classified as a condition of exclusion. In other words, IBS is usually diagnosed after all other causes of symptoms, such as infection or disease, are ruled out. This is costly, time consuming, and quite inconvenient for patients as well as for physicians. In the late '70s and early '80s researchers began to look more closely at IBS as a serious disorder and not a psychosomatic problem.

At the 13th International Congress of Gastroenterology in Rome, Italy in 1988, a group of physicians defined criteria to more accurately diagnose IBS. Known as the "Rome Criteria," this set of guidelines that outlines symptoms and applies parameters such as frequency and duration make possible a more accurate diagnosis of IBS.

The Rome Criteria has undergone several revisions and updates since its original inception. This has resulted in it becoming more helpful in diagnosing IBS. The latest incarnation was under development for 6 years and took the input of 117 experts.

The Rome IV Criteria

The Rome IV Criteria for IBS are:

Recurrent abdominal pain, on average, at least 1 day/week in the last 3 months, associated with two or more of the following criteria*:

  • Related to defecation

  • Associated with a change in frequency of stool

  • Associated with a change in form (appearance) of stool.

*Criterion fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis

In real language, this means that in order to be diagnosed with IBS, a person must have had symptoms at least 1 day a week for the last 3 months. The symptoms could should also be related to defecation (passing stool or pooping), be accompanied by a change in how often a person goes to the bathroom, and occur along with a change in how stools looks (such as being harder or looser).

There must be two of these three signs occurring with the symptoms. 

Time is another important factor in the Rome Criteria: not only must the signs and symptoms be present for the past 3 months, they must have started at least 6 months ago. This means that IBS can't be diagnosed any earlier than 6 months after symptoms began. 

There is far more to the Rome Criteria and there is a multitude of information available for physicians on how to use it to diagnose and treat patients. With every update, the Rome Criteria further refines how IBS and other functional conditions are diagnosed. It has gone from a few lines to becoming far more nuanced and detailed, which helps guide physicians in evaluating signs and symptoms of IBS. Far from being a homogeneous condition, IBS is a spectrum and people can experience different forms of it, including diarrhea-predominant and constipation-predominant, and alternating between constipation and diarrhea. What's more, there might be differences in how men and women describe the condition and react to it, and so the Rome Criteria tries to capture that as well.

Other Symptoms of IBS

Symptoms listed above in the short excerpt from the Rome Criteria are not necessarily the only indicators of IBS.

Extra intestinal symptoms of IBS can include:

  • Nausea
  • Fatigue
  • Full sensation after even a small meal
  • Vomiting

History of The Rome Criteria

The Rome Criteria were not widely accepted when originally presented, but were better received after their first revision. This second version, created in 1992 and known as Rome II, added a length of time for symptoms to be present and pain as an indicator. Rome III further expanded upon what is and is not considered IBS and was approved in 2006.

The first attempt at classifying the symptoms of IBS was known as the Manning Criteria. It was later discovered that these criteria are not specific enough and are unreliable for use with men who have IBS.

Despite these shortcomings, the Manning Criteria was a very important step in defining symptoms of IBS.

The Manning Criteria are:

  1. Onset of pain linked to more frequent bowel movements
  2. Looser stools associated with onset of pain
  3. Pain relieved by passage of stool
  4. Noticeable abdominal bloating
  5. Sensation of incomplete evacuation more than 25% of the time
  6. Diarrhea with mucous more than 25% of the time

Source:

Schmulson MJ, Drossman DA. "What Is New in Rome IV.” J Neurogastroenterol Motil. 2017 Apr; 23(2): 151–163.

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