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Rome IV Diagnostic Criteria for Irritable Bowel Syndrome (IBS)
Symptom-based diagnosis of IBS from recurrent abdominal pain linked to bowel habit.
Rome IV Diagnostic Criteria for Irritable Bowel Syndrome (IBS)
Recurrent abdominal pain, on average, at least 1 day per week in the last 3 months
Pain is related to defecation
Pain is associated with a change in stool frequency
Pain is associated with a change in stool form (appearance)
Onset ≥6 months ago, with criteria fulfilled for the last 3 months
ResultCriteria not met
Does not meet Rome IV criteria for IBS (0 of 3 associated features present; ≥2 required, plus qualifying pain frequency and duration).
- Associated features present
- 0 / 3
When to use
- Chronic recurrent abdominal pain with a bowel-habit association, to diagnose IBS without routine invasive testing when no alarm features are present.
Formula
Recurrent abdominal pain averaging ≥1 day/week over the last 3 months, associated with ≥2 of: related to defecation; associated with a change in stool frequency; associated with a change in stool form. Onset ≥6 months before diagnosis.
Pearls and pitfalls
- Alarm features (weight loss, GI bleeding, nocturnal symptoms, family history of IBD/colorectal cancer, onset after age 50) warrant investigation before relying on symptom-based criteria alone.
- IBS subtype (C, D, M, or unclassified) is assigned using the Bristol Stool Form Scale on days with abnormal bowel movements.