Rome IV Diagnostic Criteria for Irritable Bowel Syndrome (IBS)
Why Use
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.
When to 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.
Formula
Pearls / Pitfalls
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.
Management
Management of irritable bowel syndrome (IBS) is typically based on most bothersome symptoms, predominant bowel habit pattern, and severity of symptoms. Treatment may include: Dietary modifications (e.g. low FODMAP diet). Peppermint oil, soluble fiber, anti-spasmodics (e.g. hyoscyamine). For IBS-C: PEG-3350, linaclotide, lubiprostone, plecanatide, tegaserod, tenapanor. For IBS-D: Eluxadoline, rifaximin, alosetron. Neuromodulators (e.g. tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors). Psychological therapies (e.g. cognitive behavioral therapy, hypnotherapy). The choice of therapy is outside the scope of this calculator and will depend on clinical context.
Critical Actions
This calculator should only be used in patients who do not have signs or symptoms suggestive of a structural/mechanical, metabolic or systemic cause of their symptoms based on clinical history, physical exam and initial work-up.
Advice
If diagnosis not met (negative): Current symptoms are unlikely to be caused by IBS. Consider further assessment as clinically indicated. Also, see pearls and pitfalls above. If meets diagnosis (positive): Likely diagnosis of IBS. Consider initiating treatment.