Irritable bowel syndrome (IBS)
What is irritable bowel syndrome? Clinical indications and Rome IV Criteria
Irritable bowel syndrome (IBS) is a digestive disorder characterized by recurrent abdominal pain and/or discomfort associated with altered bowel movements without any identifiable structural, metabolic, or biochemical abnormalities of the digestive tract. It is classified as a disorder of gut-brain interaction (previously known as a functional digestive disorder) and significantly affects the patient's quality of life.
What are the criteria for diagnosing IBS?
The clinical manifestations of IBS are very heterogeneous, which is why expert consensus criteria have been established and used for years to define the disorder.
The first diagnostic criteria were developed by Manning and Kruis. Since the 1990s, the Rome Foundation (an international group of experts in disorders of gut-brain interaction) have updated these criteria to reflect current scientific knowledge, resulting in the Rome I, II, and III criteria, and the most up-to-date Rome IV criteria.
Rome IV Criteria for irritable bowel syndrome in adults
A) Recurrent abdominal pain on average at least one day per week in the last 3 months, associated with two or more of the following criteria:
- Related to defecation.
- Associated with a change in stool frequency.
- Associated with a change in stool form (appearance).
B) Symptoms must have started at least 6 months prior to diagnosis and the Rome IV Criteria must be fulfilled for the last 3 months.
IBS can occur in all age groups, but it mainly affects adults between 35 and 50 years of age.
Other criteria for Irritable Bowel Syndrome in children
For children and adolescents, all of the following Rome IV Criteria must be met for the diagnosis of irritable bowel syndrome:
A) Abdominal pain at least 4 days per month for at least 2 months associated with one or more of the following:
- Related to defecation.
- A change in stool frequency.
- A change in stool form (appearance).
B) In children with abdominal pain and constipation, the pain does not resolve with the resolution of constipation.
C) After appropriate medical evaluation, the symptoms cannot be attributed to another condition.
Shared symptoms: IBS, celiac disease, and gluten/wheat sensitivity
Scientists suspect that some patients diagnosed with IBS may actually have undiagnosed celiac disease. 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 people with celiac disease have similar, long-lasting, non-specific gastrointestinal complaints. Due to the specific diagnosis, celiac disease is relatively easy to rule out in cases of uncertainty. 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 diagnostic test. The diagnosis of gluten/wheat sensitivity is only valid if celiac disease and wheat allergy are ruled out and the patient responds positively to a gluten-free diet.
Sources
- Rome Group. Diagnostic criteria for disorders of gut-brain interaction: Rome IV.
- Manning AP, Thompson WG, Heaton KW, Morris AF. Towards positive diagnosis of the irritable bowel. Br Med J. 1978;2(6138):653-654.
- Kruis W, et al. A diagnostic score for irritable bowel syndrome. Gastroenterology. 1984;87(1):1-7.
- Charité Universitätsmedizin Berlin. Gluten-free diet in IBS (GIBS study).
- Glutox Study Group. Gluten and IBS: Italian multicenter study.