ROME IV criteria for functional Bowel Disorders

In June 2016, Rome IV, a comprehensive document that took 6 years to develop, was published to update the ROME III  document published in 2006. It is the result of collaboration from 117 experts from 23 countries. Rome IV includes criteria for diagnosing all functional GI disorders. The New Rome IV criteria for IBS reflect advances in recent scientific research and clinical studies, and offers several advancements in the description and diagnosis of Bowel disorders.
“Functional GI disorders are disorders of gut–brain interaction. It is a group of disorders classified by GI symptoms related to any combination of the following: 

  • Disturbances in movement of food and food waste through the GI tract (“motility disorder”)
  • Increased  subjective experience of pain in visceral organs (“visceral hypersensitivity”)
  • Alterations in gut immunity (“altered mucosal and immune function”)
  • Alterations to the commensal bacteria in the gut (“altered gut microbiota”)
  • Alterations in messages between  the brain and the gut (“altered central nervous system processing”)

This implies that there is a bidirectional interactions between  bodily processes and the gut, leading to  functional GI disorders. Rome IV places a strong emphasis on emphasis on a biopsychosocial approach in the treatment of functional GI disorders.

Hence the recommended approach is to consider:

  • Early life influences: Genetic factors, cultural norms, environmental factors.

  • Psychosocial factors: stress, personality, psychological state, coping, social support.
  • Physiology: motility, sensation, immune function, microflora, food, diet.

ROME IV Criteria for Diagnosing IBS

Recurrent abdominal pain, on average, at least 1 day/week in the last 3 months, associated with two or more of the following :

  • Related to defecation.
  • Associated with a change in frequency of stool.
  • Associated with a change in form (appearance) of stool.
  • Criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis.

Identifying IBS Subtypes
The three main subtypes of IBS are described in the table below:

  • IBS-C (predominant constipation),
  • IBS-D (predominant diarrhea), and
  • IBS-M (IBS with mixed bowel habits), as shown in Table 2.2
  • People whose symptoms do not fit into any category are considered to have IBS unclassified.