Rome III: New Diagnosis criteria for IBS

Top gastrointestinal disease experts collaborated in 2006 on new diagnostic criteria and sub-typing for irritable bowel syndrome (IBS). Since the first collaboration in 1978, resulting in the Manning Criteria, doctors have continually updated diagnostic criteria based on ongoing research. Having diagnostic criteria for IBS is particularly important because there is no laboratory test for this condition.

Medical professionals are increasingly accepting functional gastrointestinal disorders (FGIDs), which are prevalent throughout the world, as legitimate health conditions. The Rome Foundation has taken on the challenge of establishing symptom-based diagnostic criteria. The newest modification of the criteria, Rome III, was recently completed and presented at a symposium at this year’s Digestive Diseases Week (DDW) meeting. Through a series of presentations, Rome Foundation Board members revealed new rationales prepared by 100 international experts involved in the Rome III process. Dr. Douglas Drossman, President of the Rome Foundation, chaired the DDW symposium.

The proposed new sub-typing of IBS based on stool consistency alone is:

• IBS with constipation (IBS-C),
• IBS with diarrhea (IBS-D),
• IBS mixed type (IBS-M), and
• IBS unsubtyped (IBS-U).

Patients with IBS-M, formerly classed as IBS-A, or alternating, have both hard and loose stools over periods of hours or days, whereas IBS patients with alternating bowel habits change subtype over periods of weeks and months. They base stool form on the Bristol stool scale, which categorizes stool form and correlates best with colon transit times. Stability and association with other features, such as visceral sensitivity and response to treatment, remain to be determined.

Future plans for the Rome Foundation include global educational programs, support for validation studies, partnering with regulatory agencies, working team initiatives (e.g. guidelines for brain imaging and guidelines for severity in FGID working teams), and diversification of structure.

Rome III Diagnostic Criteria for Irritable Bowel Syndrome

At least three months, with onset at least six months previously, of recurrent abdominal pain or discomfort* associated with two or more of the following:

• Improvement with defecation; and/or
• Onset associated with a change in frequency of stool; and/or
• Onset associated with a change in form (appearance) of stool.

*Discomfort means an uncomfortable sensation not described as pain.

Staff Writers
First published in The Inside Tract® Newsletter Issue 158 November/December 2006