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Gastroenterology & Hepatology General Practice Strong — Rome IV / NICE NG61

Rome IV Criteria for Irritable Bowel Syndrome

Rome IV diagnostic criteria for IBS: recurrent abdominal pain ≥ 1 day/week for 3 months, associated with defaecation or stool change.

At least 1 day per week on average for the last 3 months (symptom onset ≥ 6 months ago)

Rectal bleeding, unintentional weight loss, nocturnal symptoms, age > 50 at onset, family history CRC/IBD/coeliac

Score interpretation

IBS Criteria Not Met -10–2

Rome IV criteria not met OR red flags present requiring investigation before IBS diagnosis.

→ If red flags: urgent investigation (colonoscopy, FBC, CRP, coeliac serology, faecal calprotectin). If no red flags but criteria not met: consider functional dyspepsia, IBD, coeliac disease. Re-assess symptoms over time.

Possible IBS 3–4

Abdominal pain ≥ 1 day/week but only 1 of the 3 associated features.

→ Consider IBS. Check: FBC, CRP, coeliac serology, stool calprotectin (to exclude IBD). Review medications. Dietary assessment. Consider low-FODMAP diet trial with dietitian input.

IBS Criteria Met 5–99

Rome IV criteria met for IBS: recurrent pain ≥ 1 day/week + ≥ 2 of 3 associated features.

→ Subtype: IBS-C (constipation predominant), IBS-D (diarrhoea predominant), IBS-M (mixed), IBS-U (unclassified). Investigations: FBC, CRP, coeliac serology, stool calprotectin. Management: dietary advice (low-FODMAP), antispasmodics (mebeverine, buscopan), loperamide for IBS-D, laxatives for IBS-C. Psychological support if refractory. BSG/NICE NG61.

Interpretation bands for the Rome IV IBS. Apply clinical judgement and local guidance.

References

Related

Curated clinical cross-links plus same-class fallbacks.

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Drugs

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.