Manning Criteria for Diagnosis of Irritable Bowel Syndrome (IBS)

Manning Criteria for IBS

Pain Relieved by Defecation

More Frequent Stools with Pain Onset

Looser Stools with Pain Onset

Visible Abdominal Distension

Passage of Mucus Per Rectum

Sensation of Incomplete Evacuation

Score:–

–

Determines likelihood of irritable bowel syndrome diagnosis based on clinically significant criteria.

Why Use

The symptoms that define IBS are subjective and self-reported, making a diagnostic classification system helpful. Moreover, there is evidence to support the notion that patients meeting criteria may be more likely to respond to some therapies.

When to Use

Patients being evaluated for possible IBS.

Formula

Addition of positive criterion. Onset of pain linked to more frequent bowel movements Looser stools associated with onset of pain Pain relieved by passage of stool Noticeable abdominal bloating Sensation of incomplete evacuation more than 25% of the time Diarrhea with mucus more than 25% of the time

Pearls / Pitfalls

The Manning Criteria were developed through patient survey and follow-up. They differentiate patients with organic and non-IBS conditions. Points to keep in mind: Studies have found highly variable diagnostic performance of the criteria.

Management

We are unaware of validated management algorithms using the Manning Criteria.

Critical Actions

IBS is a ‘rule-out’ diagnosis, which is to say all other possibilities must be ruled out first.

Advice

The Manning Criteria were developed to help predict which patients will de diagnosed with IBS, i.e. will not have any organic disease identified after complete work-up. In a setting where work-up resources are limited, or take undue time, these may be particularly useful.

More Information

If no red flag signs are present, a patient likely has IBS when at least 3 of the 6 criteria are met with 63-90% sensitivity and 70-93% specificity.