Irritable bowel syndrome Diagnostic Study of Choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

Diagnostic Criteria

• According to the Rome IV, the diagnosis of IBS is made when at least two of the following diagnostic criteria are met:
• Patient must have pain in the abdomen (On an average, ≥1 day per week, in the previous 3 months) with an onset of ≥6 months before diagnosis:
  • Change in stool frequency
  • Change in stool consistency
  • Pain related to defecation
  • Patient must have none of the following warning signs:
    1. Unintentional loss of weight
    2. Age ≥50 years, without previous colon cancer screening
    3. Recent change in bowel habit
    4. Hematochezia or melena i.e. evidence of overt gastrointestinal bleeding
    5. Nocturnal pain in the abdomen or passage of stools
    6. History of inflammatory bowel disease or colorectal cancer in the family
    7. Palpable abdominal mass or presence of lymphadenopathy
    8. Positive fecal occult blood test
    9. Blood testing showing evidence of iron deficiency anemia

American Gastroenterological Association Guidelines for Diagnosis of IBS

The American Gastroenterological Association has published a set of guidelines for tests which physicians should perform prior to diagnosing irritable bowel syndrome. The following tests are meant to exclude other causes, such as infection and colon cancer.

1. History and physical examination
2. Diagnostic testing
   1. CBC
   2. Chemistry panel
   3. Sedimentation rate
   4. Stool for O & P
   5. Stool for occult blood
   6. Flexible sigmoidoscopy
   7. IF > 50, colonoscopy or barium enema and sigmoidoscopy
   8. For diarrhea predominant:
      1. Small bowel radiograph
      2. Lactose/dextrose H2 breathing test
   9. For constipation predominant:
      1. Fiber trial
   10. For pain predominant:
       1. Plain film of abdomen

The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].

OR

The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].

OR

The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].

OR

There are no established criteria for the diagnosis of [disease name].

• All the criteria described for IBS are listed below in reverse chronological order:

Diagnostic criteria	Symptoms, signs and labs
2016: Rome IV	To establish the diagnosis, the patient must have recurrent pain in the abdomen (On an average, ≥1 day per week, in the previous 3 months) with an onset of ≥6 months before diagnosis- Pain in the abdomen must be associated with at least two of the following: Change in stool frequency Change in stool appearance or form Pain related to defecation Patient must have none of the following warning signs: Unintentional loss of weight Age ≥50 years, without previous colon cancer screening Recent change in bowel habit Hematochezia or melena i.e. evidence of overt gastrointestinal bleeding Nocturnal pain in the abdomen or passage of stools History of inflammatory bowel disease or colorectal cancer in the family Palpable abdominal mass or presence of lymphadenopathy Positive fecal occult blood test Blood testing showing evidence of iron deficiency anemia
2006: Rome Ⅲ	Recurrent pain in the abdomen or discomfort at least three days a month, for the last three months associated with two or more of the following(should be present  for at least twenty five percent of the time)   Onset of symptoms associated with a change in stool form(alternating between diarrhea and constipation)  Onset of symptoms associated with a change in stool frequency   Improvement with defecation   Absence of evidence of anatomic, inflammatory, neoplastic or metabolic causes to explain the symptoms
1999: Rome Ⅱ	Pain in the abdomen or abdominal discomfort that has two of the following three features for twelve weeks(which may not be consecutive) in the last one year: Onset associated with a change in stool form Onset associated with alterations in stool frequency Relief with defecation
1990: Rome Ⅰ	Abdominal discomfort or pain relieved with defecation or associated with change in frequency or consistency of stool in addition to two or more of the following (on at least twenty five percent of occasions/days for three months): 1.     Altered stool form 2.     Altered stool frequency 3.     Altered stool passage 4.     Passage of mucus in stool 5.     Abdominal bloating or distension
1984: Kruis	Symptoms of IBS must be present for more than two years. These symptoms include the following: 1.     Pain in the abdomen, flatulence 2.     Alternating constipation and diarrhea Signs that exclude IBS are determined by the physician. They are as follows: 1.     Abnormal physical findings and/or history suggestive of any other diagnosis 2.     ESR more than 20mm/2h 3.     Anemia(Hemoglobin < 12 for women or < 14 for men) 4.     Leukocytosis > 10000/cc 5.     Bleeding per rectum found on physical exam
1978: Manning	A threshold of at least three positive symptoms needs to be present to diagnose IBS with no duration of symptoms described under this classification. 1)     Loose stools with onset of pain 2)     Increased frequency of stools with onset of pain 3)     Mucus per rectum 4)     Visible distension of abdomen reported by the patient 5)     Pain in the abdomen relieved by defecation 6)     Sensation of incomplete evacuation