What is irritable bowel syndrome? Clinical keys and Rome IV criteria

The clinical manifestations of IBS are heterogeneous, which is why criteria developed by expert consensus have been used for years to define the disorder.

The first criteria used were those of Manning and Kruis. Since the 1990s, the Rome Group (an international group of experts on functional disorders) have agreed on criteria that are adapted to current knowledge, resulting in the Rome I, II and III criteria, and the currently valid Rome IV criteria.

For children and young people, the Rome IV criteria are used to investigate the existence of IBS:

A) Abdominal pain at least 4 days per month associated with one or more of the following for at least 2 months prior to diagnosis:

• Related to defecation.
• Changes in bowel movement frequency.
• Changes in the shape or appearance of stools.

B) In children with constipation, the pain does not resolve with the resolution of constipation.

C) After appropriate medical evaluation, the symptoms cannot be attributed to another condition.

Patients with IBS may be undiagnosed coeliac patients. Some studies, such as the GIBS ("Gluten-free diet in IBS") study at Charité University Hospital in Berlin or the Glutox studies in Italy, have focused on this field. Both patients with irritable bowel syndrome and coeliac patients experience similar, long-lasting, non-specific gastrointestinal complaints. Due to the specific diagnosis, coeliac disease is relatively easy to rule out in cases of doubt. However, in the case of gluten/wheat sensitivity, which must also be taken into consideration and is often accompanied by cognitive symptoms, there is currently no specific test. The diagnosis of gluten/wheat sensitivity is only valid if coeliac disease and wheat allergy are ruled out and there is a positive response to a gluten-free diet.