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Diagnostic Criteria



In the absence of a biologic disease marker, efforts have been made to standardize the diagnosis of irritable bowel syndrome using symptom based criteria. The most used criteria for diagnosis of IBS are the so called Rome criteria. In an effort to standardize clinical research, an international working team published a consensus definition in 1992 called the Rome criteria. The most recent revision was published in 2005 (Rome III criteria). Concerning the Rome definition, see also Table 1 and 2.

Irritable Bowel Syndrome can be diagnosed based on at least 12 weeks (which need not be consecutive) in the preceding 12 months, of abdominal discomfort or pain that has two out of three of these features:

1.  Relieved with defecation; and/or

2.  Onset associated with a change in frequency of stool; and/or

3.  Onset associated with a change in form (appearance) of stool.

Symptoms that Cumulatively Support the Diagnosis of IBS1:

1. Abnormal stool frequency (may be defined as greater than 3 bowel movements per day and less than 3 bowel movements per week)

2. Abnormal stool form (lumpy/hard or loose/watery stool)

3. Abnormal stool passage (straining, urgency, or feeling of incomplete evacuation)

4. Passage of mucus

5. Bloating or feeling of abdominal distension

Red Flag symptoms which are NOT typical of IBS8:

  • Pain that often awakens/interferes with sleep
  • Diarrhea that often awakens/interferes with sleep
  • Blood in your stool (visible or occult)
  • Weight loss
  • Family history of colorectal cancer, inflammatory bowel disease or celiac sprue
  • Abnormal physical examination
  • Abnormal lab values such as anaemia, elevated inflammatory markers, or electrolyte disturbances 

Four subtypes of IBS are recognized1:

  • IBS with constipation (IBS-C) (hard or lumpy stools ≥25 percent / loose or watery stools <25 percent of bowel movements)
  • IBS with diarrhea (IBS-D) (loose or water stools ≥25 percent / hard or lumpy stools <5 percent of bowel movements)
  • Mixed IBS (IBS-M) (hard or lumpy stools ≥25 percent / loose or watery stools ≥25 percent of bowel movements)
  • Unsubtyped IBS (insufficient abnormality of stool consistency to meet the above subtypes)
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