Modification of Criteria for Diagnosing Irritable Bowel Syndrome in Clinical Practice
The Rome criteria for diagnosing disorders of gut-brain interaction (DGBI) have recently been modified due to discrepancies with their use in clinical practice. The Rome Foundation board has created modified Rome IV diagnostic criteria. When caring for patients with DGBI, including irritable bowel syndrome (IBS), it will be possible to diagnose even with shorter duration and lower frequency of symptoms.
Reasons for Modifying Rome IV Criteria
The Rome criteria for diagnosing DGBI, which include irritable bowel syndrome, are used for epidemiological research, pathophysiological and therapeutic studies, and clinical practice. However, the requirement for high frequency and long duration of symptoms complicates their clinical use in patient care. The modified criteria for clinical practice therefore retain the nature and bothersome character of symptoms but lower the threshold for frequency and duration, provided that other possible diagnoses are safely excluded.
Rome Criteria for Diagnosing DGBI in Practice
The Rome Foundation board recommends the following:
- The qualitative criteria of symptoms must be maintained.
- Symptoms must be bothersome – the patient seeks medical help for these symptoms or they interfere with the patient's daily activities (personal or professional), i.e., they affect the quality of life.
- The frequency of symptoms can be lower than the threshold stated in the Rome IV criteria if the previous conditions are met.
- The duration of symptoms for 6 months, as stated in the Rome IV criteria, is not necessary in clinical practice. To ensure it is not another diagnosis, the recommended duration of symptoms is 8 weeks.
Irritable Bowel Syndrome
For IBS, the qualitative diagnostic criterion is recurrent abdominal pain on average at least 1 day per week in the last 3 months meeting ≥ 2 of the following conditions:
- related to defecation
- associated with a change in the frequency of stool
- associated with a change in the appearance of stool
IBS is further divided into clinical subtypes based on stool appearance on days with symptoms:
- with predominant constipation
- with predominant diarrhea
- mixed type
- unclassified type
The latter can only be determined in patients who are not taking medication at the time. In addition to dietary adjustments, lifestyle changes, psychotherapeutic treatment, and pharmacotherapy, the medical device PROIBS, which acts as a prebiotic, can also be used to alleviate symptoms of IBS without predominant constipation.
Conclusion
In clinical practice, it is necessary to exclude other possible causes according to clinical manifestations or other examinations when using the modified diagnostic criteria. These criteria do not replace the Rome IV criteria for clinical, epidemiological, or pathophysiological studies. Their use in practice when caring for patients should enable doctors to make timely diagnoses, reduce unnecessary diagnostic procedures, and improve doctor-patient relationships.
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Source: Drossman D. A., Tack J. Rome Foundation clinical diagnostic criteria for disorders of gut-brain interaction. Gastroenterology 2022 Mar; 162 (3): 675–679, doi: 10.1053/j.gastro.2021.11.019.
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