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Gastroenterology & Hepatology General Practice Strong — Rome IV / NICE CG61

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

Rome IV IBS Criteria Not Met 0

Pain at least 1 day/week with 2 or more of the 3 associated features is required.

→ Consider other functional bowel disorders, coeliac disease and IBD (FBC, CRP, coeliac serology, faecal calprotectin); re-assess symptoms over time.

IBS Criteria Met 1

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 CG61.

Alarm Features — Investigate Before Diagnosing IBS 2

Red flag features are present; IBS should not be diagnosed until they are investigated.

→ Investigate promptly (colonoscopy, FBC, CRP, coeliac serology, faecal calprotectin) and use the suspected cancer pathway where criteria are met (NICE NG12).

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

References

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Drugs

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