Irritable Bowel Syndrome: Straightening the road from the Rome criteria

Abstract

The concept of positive diagnosis of irritable bowel syndrome (IBS) based on symptoms kicked off with studies from the University of Bristol; Manning et al identified 4 symptoms that were clearly more common in patients with IBS: abdominal distension as evidenced by tight clothing or visible appearance; pain relief with bowel action; more frequent stools with the onset of pain; and looser stools with the onset of pain. 1 Justification for the development of symptom-based criteria for irritable bowel syndrome is based on the perspectives of several stakeholders: From the patient perspective, effective diagnostic criteria would be expected to improve outcomes by enabling clinicians to diagnose and choose treatments that are likely to be effective. For researchers, accepted criteria would be expected to stratify patient cohorts for research studies. For industry involved in the development of novel approaches to treatment, the availability of effective, evidence-based criteria enables the development of such treatments and convinces regulators and payers that functional gastrointestinal disorders and, specifically, irritable bowel syndrome are real disorders that are amenable to efficacious treatments. A sequence of consensus-based Rome criteria for IBS has been published since 1989 2-5 (Table 1). The fundamental definition based on abdominal pain in association with bowel dysfunction has been consistent. However, 2 major changes occurred in the Rome II and IV criteria. The former change involved "splitting off" of symptoms that were not consistently associated with pain, such as functional, constipation, diarrhea, and bloating. In Rome IV, the main changes have been the exclusion of discomfort (in

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“…3,7 In general, the prevalence of IBS tends to decrease when the stricter Rome IV criteria for abdominal pain are applied, since many patients with an IBS diagnosis according to the previous criteria are now classified as having other functional lower gastrointestinal disorders. 14 Similar trends were reported in a recent systematic review on the global prevalence of IBS according to Rome IV criteria. 5 A recent local study showed that the prevalence of IBS according to Rome IV criteria was significantly higher compared with that reported by previous local studies that used the older Rome criteria.…”

Obesity Exacerbates Irritable Bowel Syndrome-Related Sleep and Psychiatric Disorders in Women With Polycystic Ovary Syndrome

“…In addition, the Rome IV criteria include ‘abdominal pain’ and exclude ‘abdominal discomfort’, and also include more stringent frequency criteria. The use of the Rome IV criteria has greatly reduced the prevalence of reported IBS, so this system may be less suitable for an epidemiological survey such as this one ( 8 , 19 ).…”

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“…The Rome Foundation consensus process has also been criticized for its symptom‐based and symptom‐clustering approach and for the anatomical basis of its subdivision. In this issue of Neurogastroenterology and Motility , Dr. Michael Camilleri contributed a paper arguing in favor of abandoning diagnoses based on symptom clusters for bowel disorders, to focus on the identification of underlying pathophysiological mechanisms to guide diagnosis and treatment, with a focus on bowel disorders 6 . Even though most active clinical researchers within this field, including the authors of this article, aim toward finding support for a more pathophysiology‐ or biomarker‐based approach in the clinical management and diagnostic approach to these patients, there is insufficiently robust scientific evidence for widely introducing this approach in the general clinical setting.…”