Comparison of the Rome IV criteria with the Rome III criteria for the diagnosis of irritable bowel syndrome in secondary care

Abstract

ObjectivesDespite being proposed 4 years ago, there has been no independent validation study of the Rome IV criteria for IBS. We assessed their performance for the diagnosis of IBS in secondary care and compared them with the previous iteration, the Rome III criteria.DesignWe collected complete symptom data from consecutive adult patients with suspected IBS referred to a single UK clinic. All subjects underwent relatively standardised workup, with assessors blinded to symptom status. The reference standard used to confirm IBS was the presence of lower abdominal pain or discomfort in association with altered stool form or frequency, in a patient with no evidence of organic gastrointestinal disease after investigation. Sensitivity, specificity and positive and negative likelihood ratios (LRs), with 95% CIs, were calculated for each of the diagnostic criteria.ResultsThe level of agreement between the Rome IV and Rome III criteria was good (kappa=0.65). Compared with the reference standard, sensitivity and specificity of the Rome IV criteria in 572 patients (431 (75.3%) women, mean age 36.5 years) were 82.4% and 82.9%, respectively. Positive and negative LRs for the Rome IV criteria were 4.82 (95% CI 3.30 to 7.28) and 0.21 (95% CI 0.17 to 0.26), respectively. The Rome IV criteria performed best in those with IBS with constipation or mixed bowel habits. In 471 patients (350 (74.3%) women, mean age 36.7 years), compared with the reference standard, the sensitivity and specificity of the Rome III criteria were 85.8% and 65.0%; positive and negative LRs were 2.45 (95% CI 1.90 to 3.27) and 0.22 (0.16 to 0.29), respectively. Incorporating mood and extraintestinal symptom reporting into diagnostic criteria did not improve their performance significantly.ConclusionsThe Rome IV criteria performed significantly better than the Rome III criteria in diagnosing IBS in this single centre secondary care study, although the clinical relevance of this is uncertain.

British Society of Gastroenterology guidelines on the management of irritable bowel syndrome

“…In a patient with normal investigations from primary care on referral, exhibiting typical symptoms, and in the absence of alarm symptoms or signs, or atypical features, the diagnosis of IBS is secure (figure 1). A validation study of the Rome IV criteria in secondary care demonstrated this was particularly the case for IBS-C and IBS-M. 21 Patients meeting these criteria were 21 times more likely to have IBS-C than to not have IBS-C, and 11 times more likely to have IBS-M than to not have IBS-M after limited diagnostic workup. The clinician should, therefore, appear confident and, after clinical assessment is complete, communicate a positive diagnosis of IBS based on symptoms.…”

“…19 The fall in prevalence in IBS that results from the changes made in moving from the Rome III to Rome IV criteria is noteworthy, reflecting the more restrictive nature of the latter. This has important clinical implications because, although as intended, the criteria are now more specific for diagnosing IBS, 21 up to 50% of patients who believe they have IBS will no longer meet criteria for the condition. Instead, they will be diagnosed as having another functional bowel disorder, 22 23 such as functional diarrhoea, functional constipation or functional abdominal bloating or distension.…”

Longitudinal follow‐up of a novel classification system for irritable bowel syndrome: natural history and prognostic value

“…It is characterised by a specific pattern of gastrointestinal symptoms, namely, altered stool form or frequency in association with abdominal pain, 1 and is diagnosed using the Rome criteria. These criteria have been revised three times since their inception, to make them more specific for diagnosing IBS, 2 and the latest iteration, Rome IV, was published in 2016 1 . Rome IV also redefined IBS as a disorder of gut–brain interaction, in recognition of the complex interplay between biological, psychological and social factors in its pathogenesis.…”

Systematic review and network meta‐analysis: efficacy of licensed drugs for abdominal bloating in irritable bowel syndrome with constipation

“…Therefore, confounding due to underlying differences between RCTs, including patient characteristics, IBS severity and diagnostic criteria over the 20‐year range these trials were conducted is possible. The Rome IV criteria are more specific than their predecessors, 73 but seem to select a group of patients with more severe symptoms and higher levels of psychological comorbidity 74 . Whether the findings of this study are applicable to those with Rome IV criteria IBS is unclear.…”