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 very inconvenient for patients as well as 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 Rome Criteria

The Rome III Criteria for IBS are:

Diagnostic criterion* 

Recurrent abdominal pain or discomfort** at least 3 days/month in the last 3 months associated with two or more of the following:

  1. Improvement with defecation
  2. Onset associated with a change in frequency of stool
  3. Onset 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

**“Discomfort” means an uncomfortable sensation not described as pain.

In pathophysiology research and clinical trials, a pain/discomfort frequency of at least 2 days a week during screening evaluation is recommended for subject eligibility.

In real language, this means that in order to be diagnosed with IBS, a person must have had symptoms at least 3 days a month for the last 3 months. The symptoms could include pain, bloating, or urgency. There must also be two of the three signs occurring with the symptoms. The first sign is that symptoms get better after going to the bathroom.

The second sign is that the symptoms started at the same time as stools became more or less frequent. The third sign is that the symptoms started at the same time stools changed, such as becoming diarrhea or constipation. 

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 diagnosis. 

The last part of the criteria refers to clinical trials. When clinical trials are done, for instance on new medication to treat IBS, or to understand more about IBS in general, people participating in the trial should have signs and symptoms at least 2 days a week.

Other Symptoms of IBS

Symptoms in the Rome Criteria are not necessarily the only indicators of IBS. Extra intestinal symptoms 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 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:

Rome Foundation, Inc. "Appendix A: Rome III Diagnostic Criteria for Functional Gastrointestinal Disorders." RomeFoundation.org 2015.

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