Kruis Score for Diagnosis of Irritable Bowel Syndrome
Validated clinical scoring system for the diagnosis of IBS in primary and secondary care. Uses symptom items and alarm feature exclusions. Originally described by Kruis et al. 1984. Positive score (above 44) has sensitivity ~75-78% and specificity ~85% for IBS diagnosis. Useful to differentiate IBS from organic GI disease. Has been largely superseded by Rome IV criteria but remains in clinical use.
Score interpretation
Kruis above 44 -- positive test; IBS diagnosis supported in absence of alarm features
→ IBS diagnosis supported; confirm using Rome IV criteria (abdominal pain at least 1 day/week for last 3 months, onset above 6 months ago, plus 2 of: pain related to defaecation, change in stool frequency, change in stool form); exclude alarm features: blood in stool, nocturnal symptoms, unexplained weight loss, family history CRC/IBD/coeliac, onset above 50 years, progressive symptoms; if no alarms: manage IBS -- dietary advice (low FODMAP diet, dietitian referral), antispasmodics (hyoscine butylbromide 10-20 mg TDS), loperamide if IBS-D, laxatives if IBS-C; refer to gastroenterology if refractory; psychological support (CBT, gut-directed hypnotherapy).
Kruis at or below 44 -- IBS less likely; investigate for organic GI disease
→ IBS diagnosis not supported; investigate for organic disease: FBC, CRP, coeliac serology (IgA-tTG), faecal calprotectin (if above 50-100 mcg/g: colonoscopy for IBD); thyroid function if diarrhoea predominant; review medications (laxatives, metformin, PPIs); if blood in stool: urgent 2-week-wait colorectal referral (NICE NG12); if anaemia or elevated CRP: colonoscopy; if above 50 with new bowel symptoms: colonoscopy; document alarm features and investigations in notes.
Interpretation bands for the Kruis IBS Score. Apply clinical judgement and local guidance.
References
- Kruis W et al. A diagnostic score for the irritable bowel syndrome. Its value in the exclusion of organic disease. Gastroenterology. 1984;87(1):1-7.
- NICE NG12. Suspected cancer: recognition and referral. NICE. 2015 (updated 2023). Colorectal cancer section.
Related
Curated clinical cross-links plus same-class fallbacks.
- Manning Criteria for Irritable Bowel Syndrome · Functional GI Disorders
- Rome IV Diagnostic Criteria for Functional Dyspepsia · Functional GI Disorders
- Rome IV Diagnostic Criteria for Functional Constipation · Functional GI Disorders
- Rome IV Diagnostic Criteria for Functional Chest Pain · Functional GI Disorders
- Rome IV Diagnostic Criteria for Globus · Functional GI Disorders
- Rome IV Diagnostic Criteria for Cyclic Vomiting Syndrome (CVS) · Functional GI Disorders
- Risperidone (Paediatric) · Atypical Antipsychotic — Autism Spectrum Disorder / Schizophrenia / Tic Disorders
- Aciclovir 800mg Tablets (Ramsay Hunt Syndrome / Herpes Zoster Oticus) · Antiviral — nucleoside analogue (herpes zoster treatment)
- Pramipexole (Restless Legs Syndrome — Elderly) · Dopamine Agonist (D2/D3 Receptor)
- Docusate Sodium · Faecal Softener / Stimulant Laxative
- Sodium Picosulfate · Stimulant Laxative / Bowel Preparation Agent
- Citric acid · Bowel preparation component
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.