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Updated Diagnostic Criteria - Rome IV

The Rome IV criteria introduced two major changes compared to the previous Rome III criteria. 5,6  The new criteria no longer includes abdominal discomfort as part of the definition of IBS. Abdominal pain is now required  in order to meet the new diagnostic criteria.  Another important change was the change in symptom frequency:

Rome IV: Abdominal pain should be present at least 1 day per week on average during the preceding month.  Rome III:  at least 3 days per month.  The new criteria are not likely to change the incidence of IBS in clinical populations.5 


Access our IBS diagnosis calculator based on the Rome IV criteria

info  The diagnosis of IBS requires not only meeting the diagnostic criteria, but also on a limited number of additional tests based on the symptoms reported.

The Rome IV criteria also redefined the four subtypes of IBS as follows:

  • IBS with constipation (IBS-C):   >25% hard stools and <25% loose stools
  • IBS with diarrhea (IBS-D): >25% loose stools and <25% hard stools
  • IBS with mixed bowel habits (IBS-M):  >25% loose stools and >25% hard stools
  • Unclassified IBS (IBS-U):  <25% loose stools and <25% hard stools.

This new approach is more likely to reflect experience from clinical practice and should substantially reduce the IBS-U group while increasing the IBS-M group.


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  1. Lovell RM , Ford AC . Global prevalence of, and risk factors for, irritable bowel syndrome: a meta-analysis . Clin Gastroenterol Hepatol 2012; 10 : 712 - 21 .
  2. Quigley EM , Abdel-Hamid H , Barbara G et al. A global perspective on irritable bowel syndrome: a consensus statement of the World Gastroenterology Organisation Summit Task Force on Irritable Bowel Syndrome . J Clin Gastroenterol 2012 ; 46 : 356 - 66 .
  3. Ford AC, et al.   American College of Gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation Am J Gastroenterol 2014 109 Suppl 1 S2-S26. PubMed.
  4. Chang, L., Lembo, A., and Sultan, S. American Gastroenterological Association technical review on the pharmacological management of irritable bowel syndrome. Gastroenterology. 2014; 147: 1149-1172.
  5. Simren M,  Palsson OS,  Whitehead WE. Update on Rome IV Criteria for Colorectal Disorders: Implications for Clinical Practice.  Curr Gastroenterol Rep. 2017; 19(4): 15.  Published online 2017 Apr 3. doi: 10.1007/s11894-017-0554-0 PMCID: PMC5378729
  6. Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology. 2016;150:1262-1279.
  7. American Gastroenterological Association Institute Guideline on the Pharmacological Management of Irritable Bowel Syndrome. Accessed: July 2017. Available at:
  8. Zuckerman MJ. The role of fiber in the treatment of irritable bowel syndrome: therapeutic recommendations. J Clin Gastroenterol. 2006 Feb;40(2):104-8.
  9. LINZESS(R) package insert.  Allergan USA, Inc. Ironwood Pharmaceuticals, Inc. Irvine, CA 92612 Cambridge, MA, 02142.  Revised: 1/2017. Accessed: July 2017.
  10. Amitiza® (lubiprostone) package insert.  Takeda Pharmaceuticals America, Inc. Deerfield, IL 60015.  Revised: 9/2016.  Accessed: July 2017.  


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Diagnostic Criteria IBS