Experts Call For Changes to the Way IBS (irritable bowel syndrome) Is Diagnosed
Experts are calling for a change to diagnostic criteria for irritable bowel syndrome (IBS) based on a reanalysis of data from recent studies
The reanalysis, which was published in the journal Gastroenterology, analyzed existing criteria that are in place to help diagnose people with IBS 1
The researchers looked at data from two previous studies on IBS: One was a cross-sectional survey of 1,375 patients in the U.K.;2 the other was a diagnostic accuracy study of the Rome IV criteria that looked at data from 577 patients at a specialized IBS clinic in the U.K.3
After making some modifications for classifying IBS, the researchers found that 1,272 people (or 92.5%) who self-identified as having IBS met the Rome IV criteria for IBS while, in the second study, 452 (or about 79%) met the criteria.
About IBS: What Is Irritable Bowel Syndrome?
Irritable bowel syndrome is a gastrointestinal disorder marked by a group of symptoms that happen together during flares.
Those include repeated pain in your abdomen with changes in bowel movements, including diarrhea, constipation, or both.
The researchers found that some of the patients who did not meet the criteria had other health conditions, like exocrine pancreatic insufficiency, Crohn’s disease, ulcerative proctitis, and microscopic colitis.1
Overall, the researchers suggested that loosening the criteria could improve the accuracy of IBS diagnoses.
What Are the Rome IV Criteria?
Rome IV criteria are diagnostic criteria that help healthcare providers identify a slew of different gastrointestinal disorders, including IBS.
While the Rome IV criteria can be helpful when diagnosing IBS, healthcare providers sometimes prefer to do a more thorough investigation as well.
In the case of IBS, Rome IV criteria currently recommend that patients meet the following in order to be diagnosed with the condition:5
Treatment Options for Irritable Bowel Syndrome (IBS)
Recurring abdominal pain that lasts, on average, at least one day a week in the last three months and is linked with two or more of the following:
- Issues with pooping
- A change in how often someone poops
- A change in the appearance of someone’s stool
Patients must also experience this for a minimum of six months before they’re diagnosed with IBS
The criteria also break things down even further by IBS sub-types, specifying what bowel movements should look like and how often someone should experience them.
The Rome criteria were updated in 2016 from Rome III to Rome IV.
These new criteria removed the word “discomfort” and changed it to “pain.” It also changed the threshold for IBS diagnosis from at least three days a month to at least one day a week.6
In the study, researchers redefined Rome IV IBS criteria more loosely as patients having two or more issues with stomach pain related to pooping, softer or harder stools when the pain started, more or less frequent stools when the pain started—with the issue lasting for three months or more.
The modified criteria also put an emphasis on whether the symptoms actually bothered the patient.
The researchers pointed out that almost 20% of people who are thought to have IBS did not meet the previous Rome III criteria, which were more restrictive.
How Might a Change in Diagnostic Criteria Help?
While the Rome criteria can be used by healthcare providers, it’s not necessarily the only way to diagnose IBS, Ashkan Farhadi, MD a gastroenterologist at MemorialCare Orange Coast Medical Center in California, told Verywell.
“This was invented for research studies,” he said. “It’s not something I use in my clinic.”
Farhadi said that loosening the criteria may help be more inclusive of other people who can qualify as having IBS but, he added, “it’s not like you didn’t have IBS yesterday and now you do with no change in your symptoms.”
Farhadi recommends that people who are having chronic pain around their bowel movements see a healthcare provider.
“Whether this is happening three days in a row, two days in a row, or once a week—if it’s chronic, you may have IBS,” he said.
“The majority of people with IBS never seek medical attention. If it’s interfering with your life and daily activity, you need to be seen.”
Bibliographic references:
- Black CJ, Ford AC. Assessing the impact of changes to the Rome IV criteria for clinical practice in irritable bowel syndrome. Gastroenterology. Published online January 22, 2022. doi:10.1053/j.gastro.2022.01.021
- Black CJ, Yiannakou Y, Houghton LA, Ford AC. Epidemiological, clinical, and psychological characteristics of individuals with self-reported irritable bowel syndrome based on Rome IV vs Rome III criteria. Clin Gastroenterol Hepatol. 2020;18(2):392-398.e2. doi:10.1016/j.cgh.2019.05.037
- Black CJ, Craig O, Gracie DJ, Ford AC. Comparison of the Rome IV criteria with the Rome III criteria for the diagnosis of irritable bowel syndrome in secondary care. Gut. 2021;70(6):1110-1116. doi:10.1136/gutjnl-2020-322519
- National Institute of Diabetes and Digestive and Kidney Diseases. Irritable bowel syndrome.
- Rome Foundation. Rome IV criteria.
- Lin L, Chang L. Benefits and pitfalls of change from Rome III to Rome IV criteria for irritable bowel syndrome and fecal incontinence. Clin Gastroenterol Hepatol. 2020;18(2):297-299. doi:10.1016/j.cgh.2019.10.004
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