IBS Rome III Criteria

Roman Colosseum, Rome, Italy.

Photo by DAVID ILIFF. License: CC-BY-SA 3.0


Rome III
– Recurrent abdominal pain or discomfort >=3 days/month in the past 3 months
– Symptom onset >= 6 months before diagnosis
– Associated with >=2 of the following:
– Improvement after defecation
– Change in stool frequency
– Change in stool form/appearance
– Suptyped according to predominant bowel habit:
– Constipation (IBS-C)
– Diarrhea (IBS-D)
– Mixed (IBS-M)
– Unclassified (IBS-U)

American College of Gastroenterology
– Abdominal discomfort associated with altered bowel habits >=3 months

Alarm features:
– Onset after age 50
– Blood in stool
– Severe or progressively worsening Sx
– Weight loss
– Iron-deficiency anemia
– Nocturnal Sx
– Family Hx of colorectal cancer, inflammatory bowel disease or celiac disease

Investigations to consider:
– Celiac disease screening, lactose intolerance testing (higher prevalence of these conditions in IBS)
– Complete blood count (anemia)
– Colonoscopy (colon cancer)
– Blood glucose (diabetes)
– Serum calcium (hypercalcemia)
– Thyroid function test (hypothyroidism)
– Abdominal ultrasound (bloating due to ascites)

1. Brant LJ, Chey WD, Foxx-Orenstein AE, et al. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 2009; 104 Suppl:S1-S35. do:10.1038/ajg.2008.122.
2. Ford AC, Moayyedi P, Lacy BE, et al. American College of Gastroenterology Monograph on the Management of Irritable Bowel Syndrome and Chronic Idiopathic Constipation. Am J Gastroenterol 2014; 109(S1):S2-S26. do:101038/ajg.2014.187