Irritable Bowel Syndrome Subtypes: New Names for Old Medical Conditions

Abstract

The irritable bowel syndrome (IBS) is the most common functional gastrointestinal disorder (FGID), also called disorders of the gut-brain interaction (DGBI). Over the years, the definition and classification of IBS suffered several conceptual changes. The work of the Rome Committees has largely contributed to the progress in knowledge and awareness of IBS. This paper is an overview of the evolution of diagnosis and classification criteria of IBS. Background: The majority of the complaints causing presentation to the general gastroenterological centers are represented by FGID. IBS is the most frequent among them. IBS is not a uniform condition but includes an array of particular forms called subtypes. Criteria for the identification of the IBS subtypes have suffered several changes in parallel with the accumulation of scientific evidence about this disorder. Classification of IBS subtypes relies on symptoms. Summary: This is a review of the evolution of the criteria for diagnosis and classification of IBS subtypes. Starting with older names given to IBS, some changes in definition and diagnosis have been operated by each edition of the Rome criteria. These changes have led to the better identification of patients with IBS. The management of IBS depends on subtypes and should be individualized. Key Messages: IBS is the main FGID, called also DGBI. It is not a homogenous disorder but a generic name for an array of subtypes with common features but with clinical differences. The diagnosis and classification of IBS subtypes have evolved in time, in accordance with the progress of the knowledge on pathogenesis. It is important for healthcare providers to recognize the subtypes and to use a common nomenclature (that offered by the Rome Committees work).

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“…Irritable bowel syndrome (IBS) is a common gastrointestinal dysfunction disease, 1,2 which is related to patients’ psychological and genetic factors. 3,4 It is mainly manifested as repeated abdominal pain, while the clinical examination is normal.…”

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“…Irritable bowel syndrome (IBS) is a multifactorial, highly prevalent functional GI disorder (10-20% in the developed world), characterized by the presence of functional alterations in the absence of evident underlying organic causes. Main alterations observed include GI motility disturbances [with predominant constipation (IBS-C), predominant diarrhea (IBS-D) or mixed bowel habits (IBS-M)], abnormal visceral sensitivity (hypersensitivity), altered epithelial barrier function (leaky gut), dysbiosis and disruptions of the brain-gut axis leading, mainly, to abnormalities in the processing of visceral afferent inputs [118][119][120][121][122]. Because of these characteristics, modulation of the ECS might be beneficial for IBS patients.…”

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“…Reference Manning criteria (Manning et al, 1978) Rome I (Drossman, 1995) Rome I & II (Hillilä & Färkkilä, 2004) Rome II (Talley et al, 1999) Rome III & IV (Grad & Dumitrascu, 2020;Lacy & Patel, 2017) Rome III (Tack & Talley, 2013) Rome IV (Stanghellini et al, 2016) Anorexia nervosa Erzegovesi and Bellodi (2016); Grad and Dumitrascu (2020) Note: This table provides a summary of the diagnostic criteria for the EDs and FGIDs considered in this systematic review.…”