Rome IV Diagnostic Criteria for Irritable Bowel Syndrome (IBS)
Official Rome IV criteria for the diagnosis of irritable bowel syndrome.
Use in patients with symptoms suggestive of irritable bowel syndrome (IBS) such as chronic and recurrent abdominal pain and/or altered bowel habits for at least 6 months.
Patients with any of the following features must be evaluated clinically for other diagnoses even though IBS may be present:
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Signs or symptoms of gastrointestinal bleeding.
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Unexplained iron deficiency anemia.
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Unintentional weight loss.
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Palpable abdominal mass or lymphadenopathy on exam.
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Family history of colon cancer and have not had age-appropriate colon cancer screening.
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Onset of symptoms age ≥50 years and have not had age-appropriate colon cancer screening.
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Sudden or acute onset of new change in bowel habit.
If diagnosis not met (negative):
Current symptoms are unlikely to be caused by IBS. Consider further assessment as clinically indicated. Also, see pearls and pitfalls above.
If meets diagnosis (positive):
Likely diagnosis of IBS. Consider initiating treatment.
Management of irritable bowel syndrome (IBS) is typically based on most bothersome symptoms, predominant bowel habit pattern, and severity of symptoms. Treatment may include:
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Dietary modifications (e.g. low FODMAP diet).
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Peppermint oil, soluble fiber, anti-spasmodics (e.g. hyoscyamine).
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For IBS-C: PEG-3350, linaclotide, lubiprostone, plecanatide, tegaserod, tenapanor.
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For IBS-D: Eluxadoline, rifaximin, alosetron.
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Neuromodulators (e.g. tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors).
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Psychological therapies (e.g. cognitive behavioral therapy, hypnotherapy).
The choice of therapy is outside the scope of this calculator and will depend on clinical context.
This calculator should only be used in patients who do not have signs or symptoms suggestive of a structural/mechanical, metabolic or systemic cause of their symptoms based on clinical history, physical exam and initial work-up.