Comparison of the Rome IV criteria with the Rome III criteria for the diagnosis of irritable bowel syndrome in secondary care
Open accessAbstract
Objectives: Despite being proposed 4 years ago, there has been no independent validation study of the Rome IV criteria for IBS. We assessed their performance for the diagnosis of IBS in secondary care and compared them with the previous iteration, the Rome III criteria. Design: We collected complete symptom data from consecutive adult patients with suspected IBS referred to a single UK clinic. All subjects underwent relatively standardised workup, with assessors blinded to symptom status. The reference standard used to confirm IBS was the presence of lower abdominal pain or discomfort in association with altered stool form or frequency, in a patient with no evidence of organic gastrointestinal disease after investigation. Sensitivity, specificity and positive and negative likelihood ratios (LRs), with 95% CIs, were calculated for each of the diagnostic criteria. Results: The level of agreement between the Rome IV and Rome III criteria was good (kappa=0.65). Compared with the reference standard, sensitivity and specificity of the Rome IV criteria in 572 patients (431 (75.3%) women, mean age 36.5 years) were 82.4% and 82.9%, respectively. Positive and negative LRs for the Rome IV criteria were 4.82 (95% CI 3.30 to 7.28) and 0.21 (95% CI 0.17 to 0.26), respectively. The Rome IV criteria performed best in those with IBS with constipation or mixed bowel habits. In 471 patients (350 (74.3%) women, mean age 36.7 years), compared with the reference standard, the sensitivity and specificity of the Rome III criteria were 85.8% and 65.0%; positive and negative LRs were 2.45 (95% CI 1.90 to 3.27) and 0.22 (0.16 to 0.29), respectively. Incorporating mood and extraintestinal symptom reporting into diagnostic criteria did not improve their performance significantly. Conclusions: The Rome IV criteria performed significantly better than the Rome III criteria in diagnosing IBS in this single centre secondary care study, although the clinical relevance of this is uncertain.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Up to 50% of patients who believe they have IBS will no longer meet criteria for the condition when moving from Rome III to Rome IV.
“up to 50% of patients who believe they have IBS will no longer meet criteria for the condition.”
From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [21]
The Introduction says Rome IV tightened the symptom requirements, and the Results report that some patients meeting Rome III did not meet Rome IV. But the paper does not report that up to 50% of patients who believe they have IBS lose eligibility; it studied a secondary-care referral population, not patients identified by that belief. (LLM, conf=0.84)
Experimental — accuracy not yet measuredPatients meeting the Rome IV criteria were 21 times more likely to have IBS-C than to not have IBS-C, and 11 times more likely to have IBS-M than to not have IBS-M after limited diagnostic workup.
“Patients meeting these criteria were 21 times more likely to have IBS-C than to not have IBS-C, and 11 times more likely to have IBS-M than to not have IBS-M after limited diagnostic workup.”
From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [21]
The Validation of the Rome IV Criteria for IBS section reports positive likelihood ratios of 25.7 for IBS with constipation and 10.6 for IBS with mixed bowel habits; the latter is approximately 11, but the former is not 21. The Introduction’s figure of 21 concerns IBS overall in an earlier validation study, not IBS-C in this study. The Investigative Work-up section describes a standardised but non-exhaustive work-up. (LLM, conf=0.89)
Experimental — accuracy not yet measuredA validation study of the Rome IV criteria in secondary care demonstrated that the diagnosis of IBS was particularly secure for IBS-C and IBS-M.
“A validation study of the Rome IV criteria in secondary care demonstrated this was particularly the case for IBS-C and IBS-M.21”
From British Society of Gastroenterology guidelines on the management of irritable bowel syndrome (2021) · cites this paper as [21]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
The Hospital Anxiety and Depression Scale
Zigmond, A. S., & Snaith, R. P. (1983) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1983.tb09716.x · Cited by 47,139 · see citing works
Longstreth, G. F., Thompson, W. G., Chey, W. D., Houghton, L. A., Mearin, F., & Spiller, R. C. (2006) · Gastroenterology · doi:10.1053/j.gastro.2005.11.061 · Cited by 4,856 · see citing works
STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies
Bossuyt, P. M., Reitsma, J. B., Bruns, D. E., Gatsonis, C. A., Glasziou, P. P., Irwig, L., Lijmer, J. G., Moher, D., Rennie, D., de Vet, H. C. W., et al. (2015) · BMJ · doi:10.1136/bmj.h5527 · Cited by 3,660 · see citing works
The PHQ-15: Validity of a New Measure for Evaluating the Severity of Somatic Symptoms
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2002) · Psychosomatic Medicine · doi:10.1097/00006842-200203000-00008 · Cited by 3,305 · see citing works
Lacy, B. E., Mearin, F., Chang, L., Chey, W. D., Lembo, A. J., Simren, M., & Spiller, R. (2016) · Gastroenterology · doi:10.1053/j.gastro.2016.02.031 · Cited by 2,866 · see citing works
Sperber, A. D., Bangdiwala, S. I., Drossman, D. A., Ghoshal, U. C., Simren, M., Tack, J., Whitehead, W. E., Dumitrascu, D. L., Fang, X., Fukudo, S., et al. (2021) · Gastroenterology · doi:10.1053/j.gastro.2020.04.014 · Cited by 2,263 · see citing works
Rome IV—Functional GI Disorders: Disorders of Gut-Brain Interaction
Drossman, D. A., & Hasler, W. L. (2016) · Gastroenterology · doi:10.1053/j.gastro.2016.03.035 · Cited by 1,928 · see citing works
FRANCIS, C. Y., MORRIS, J., & WHORWELL, P. J. (1997) · Alimentary Pharmacology & Therapeutics · doi:10.1046/j.1365-2036.1997.142318000.x · Cited by 1,708 · see citing works
Towards positive diagnosis of the irritable bowel.
Manning, A. P., Thompson, W., Heaton, K. W., & Morris, A. F. (1978) · BMJ · doi:10.1136/bmj.2.6138.653 · Cited by 1,404 · see citing works
Medically Unexplained Physical Symptoms, Anxiety, and Depression: A Meta-Analytic Review
Henningsen, P., Zimmermann, T., & Sattel, H. (2003) · Psychosomatic Medicine · doi:10.1097/01.psy.0000075977.90337.e7 · Cited by 829 · see citing works
Guidelines on the irritable bowel syndrome: mechanisms and practical management
Spiller, R., Aziz, Q., Creed, F., Emmanuel, A., Houghton, L., Hungin, P., Jones, R., Kumar, D., Rubin, G., Trudgill, N., et al. (2007) · Gut · doi:10.1136/gut.2007.119446 · Cited by 818 · see citing works
Development and Validation of the Rome IV Diagnostic Questionnaire for Adults
Palsson, O. S., Whitehead, W. E., van Tilburg, M. A. L., Chang, L., Chey, W., Crowell, M. D., Keefer, L., Lembo, A. J., Parkman, H. P., Rao, S. S. C., et al. (2016) · Gastroenterology · doi:10.1053/j.gastro.2016.02.014 · Cited by 719 · see citing works
Halpin, S. J., & Ford, A. C. (2012) · American Journal of Gastroenterology · doi:10.1038/ajg.2012.260 · Cited by 607 · see citing works
Self-citationFaecal elastase 1: a novel, highly sensitive, and specific tubeless pancreatic function test.
Löser, C., Møllgaard, A., & Fölsch, U. R. (1996) · Gut · doi:10.1136/gut.39.4.580 · Cited by 561 · see citing works
(2006) · Cited by 534 · see citing works
Zamani, M., Alizadeh‐Tabari, S., & Zamani, V. (2019) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.15325 · Cited by 496 · see citing works
Palsson, O. S., Whitehead, W., Törnblom, H., Sperber, A. D., & Simren, M. (2020) · Gastroenterology · doi:10.1053/j.gastro.2019.12.021 · Cited by 461 · see citing works
Tibble, J. A., Sigthorsson, G., Foster, F., Forgács, I., & Bjarnason, I. (2002) · Gastroenterology · doi:10.1053/gast.2002.34755 · Cited by 437 · see citing works
WEDLAKE, L., A’HERN, R., RUSSELL, D., THOMAS, K., WALTERS, J. R. F., & ANDREYEV, H. J. N. (2009) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2009.04081.x · Cited by 435 · see citing works
Aoki, Y., Belin, R. M., Clickner, R., Jeffries, R., Phillips, L., & Mahaffey, K. R. (2007) · Thyroid · doi:10.1089/thy.2006.0235 · Cited by 390 · see citing works
Sanders, D. S., Carter, M. J., Hurlstone, D. P., Pearce, A., Ward, A. M., McAlindon, M. E., & Lobo, A. J. (2001) · The Lancet · doi:10.1016/s0140-6736(01)06581-3 · Cited by 390 · see citing works
American College of Gastroenterology Monograph on Management of Irritable Bowel Syndrome
Ford, A. C., Moayyedi, P., Chey, W. D., Harris, L. A., Lacy, B. E., Saito, Y. A., & Quigley, E. M. M. (2018) · American Journal of Gastroenterology · doi:10.1038/s41395-018-0084-x · Cited by 388 · see citing works
Self-citationThe Irritable Bowel Syndrome: Long-Term Prognosis and the Physician-Patient Interaction
Owens, D. M., Nelson, D. K., & Talley, N. J. (1995) · Annals of Internal Medicine · doi:10.7326/0003-4819-122-2-199501150-00005 · Cited by 349 · see citing works
Arasaradnam, R. P., Brown, S., Forbes, A., Fox, M. R., Hungin, P., Kelman, L., Major, G., O’Connor, M., Sanders, D. S., Sinha, R., et al. (2018) · Gut · doi:10.1136/gutjnl-2017-315909 · Cited by 332 · see citing works
Spiller, R. E., Humes, D. J., Campbell, E., Hastings, M. C., Neal, K. R., Dukes, G. E., & Whorwell, P. J. (2010) · Alimentary Pharmacology & Therapeutics · doi:10.1111/j.1365-2036.2010.04402.x · Cited by 236 · see citing works
Slattery, S. A., Niaz, O., Aziz, Q., Ford, A. C., & Farmer, A. D. (2015) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.13227 · Cited by 214 · see citing works
Self-citationValidation of the Rome III Criteria for the Diagnosis of Irritable Bowel Syndrome in Secondary Care
Ford, A. C., Berčík, P., Morgan, D. G., Bolino, C., Pinto-Sánchez, M. I., & Moayyedi, P. (2013) · Gastroenterology · doi:10.1053/j.gastro.2013.08.048 · Cited by 204 · see citing works
Self-citationLankisch, P. G., Schmidt, I., König, H., Lehnick, D., Knollmann, R., Löhr, M. J., & LIEBE, S. (1998) · Gut · doi:10.1136/gut.42.4.551 · Cited by 185 · see citing works
Sainsbury, A., Sanders, D. S., & Ford, A. C. (2012) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2012.11.033 · Cited by 174 · see citing works
Self-citationIrvine, A. J., Chey, W. D., & Ford, A. C. (2017) · American Journal of Gastroenterology · doi:10.1038/ajg.2016.466 · Cited by 172 · see citing works
Self-citationIrritable bowel syndrome in adults in primary care: summary of updated NICE guidance
Hookway, C., Buckner, S., Crosland, P., & Longson, D. (2015) · BMJ · doi:10.1136/bmj.h701 · Cited by 148 · see citing works
Whitehead, W. E., Crowell, M. D., Bosmajian, L. S., Zonderman, A. B., Costa, P. T., Benjamin, C., Robinson, J. C., Heller, B., & Schuster, M. M. (1990) · Gastroenterology · doi:10.1016/0016-5085(90)90822-i · Cited by 134 · see citing works
Ford, A. C. (2008) · JAMA · doi:10.1001/jama.300.15.1793 · Cited by 128 · see citing works
Self-citationBlack, C. J., Yiannakou, Y., Houghton, L. A., & Ford, A. C. (2020) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2019.05.037 · Cited by 123 · see citing works
Self-citationEvaluation of patients who meet clinical criteria for irritable bowel syndrome.
Tolliver, B. A., Herrera, J. L., & DiPalma, J. A. (1994) · PubMed · Cited by 121 · see citing works
Patel, P., Bercik, P., Morgan, D. G., Bolino, C., Pintos‐Sanchez, M. I., Moayyedi, P., & Ford, A. C. (2015) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.13074 · Cited by 115 · see citing works
Self-citationEffect of Increased Bile Acid Synthesis or Fecal Excretion in Irritable Bowel Syndrome-Diarrhea
Camilleri, M., Busciglio, I., Acosta, A., Shin, A., Carlson, P., Burton, D., Ryks, M., Rhoten, D., Lamsam, J., Lueke, A., et al. (2014) · American Journal of Gastroenterology · doi:10.1038/ajg.2014.215 · Cited by 114 · see citing works
Some Patients With Irritable Bowel Syndrome May Have Exocrine Pancreatic Insufficiency
Leeds, J. S., Hopper, A. D., Sidhu, R., Simmonette, A., Azadbakht, N., Hoggard, N., Morley, S., & Sanders, D. S. (2010) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2009.09.032 · Cited by 109 · see citing works
Vork, L., Weerts, Z. Z. R. M., Mujagic, Z., Kruimel, J. W., Hesselink, M. A. M., Muris, J. W. M., Keszthelyi, D., Jonkers, D. M. A. E., & Masclee, A. A. M. (2018) · Neurogastroenterology & Motility · doi:10.1111/nmo.13189 · Cited by 101 · see citing works
Macaigne, G., Lahmek, P., Locher, C., Lesgourgues, B., Costes, L., Nicolas, M. P., Courillon-Mallet, A., Ghilain, J.-M., Bellaïche, G., de Montigny-Lehnardt, S., et al. (2014) · American Journal of Gastroenterology · doi:10.1038/ajg.2014.182 · Cited by 87 · see citing works
Aziz, I., Mumtaz, S., Bholah, H., Chowdhury, F. U., Sanders, D. S., & Ford, A. C. (2015) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2015.03.002 · Cited by 87 · see citing works
Self-citationSpiegel, B. M. R., Gralnek, I. M., Bolus, R., Chang, L., Dulai, G. S., Naliboff, B., & Mayer, E. A. (2005) · Gastrointestinal Endoscopy · doi:10.1016/j.gie.2005.08.016 · Cited by 87 · see citing works
Sood, R., Gracie, D. J., Law, G. R., & Ford, A. C. (2015) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.13283 · Cited by 86 · see citing works
Self-citationIrritable Bowel Syndrome and Microscopic Colitis: A Systematic Review and Meta-analysis
Kamp, E. J. C. A., Kane, J. S., & Ford, A. C. (2015) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2015.09.031 · Cited by 80 · see citing works
Self-citationQuantifying bile acid malabsorption helps predict response and tailor sequestrant therapy
Orekoya, O., McLaughlin, J., Leitao, E., Johns, W., Lal, S., & Paine, P. (2015) · Clinical Medicine · doi:10.7861/clinmedicine.15-3-252 · Cited by 74 · see citing works
Sood, R., Camilleri, M., Gracie, D. J., Gold, M. J., To, N., Law, G. R., & Ford, A. C. (2016) · The American Journal of Gastroenterology · doi:10.1038/ajg.2016.308 · Cited by 60 · see citing works
Self-citationQuantifying bile acid malabsorption helps predict response and tailor sequestrant therapy
Orekoya, O., McLaughlin, J. T., Leitao, E., Johns, W., Lal, S., & Paine, P. (2015) · Clinical Medicine · doi:10.7861/clinmedicine.15-4-371 · Cited by 50 · see citing works
Durability of the Diagnosis of Irritable Bowel Syndrome Based on Clinical Criteria
Adeniji, O. A., Barnett, C. B., & Di Palma, J. A. (2004) · Digestive Diseases and Sciences · doi:10.1023/b:ddas.0000026300.47363.3b · Cited by 37 · see citing works
Talley, N. J., Holtmann, G., Nguyen, Q. N., Gibson, P., Bampton, P., Veysey, M., Wong, J., Philcox, S., Koloski, N., Bunby, L., et al. (2017) · Journal of Gastroenterology and Hepatology · doi:10.1111/jgh.13791 · Cited by 28 · see citing works
Banerjee, R., Ong, W. C., Gupta, R., Tandan, M., Lakhtakia, S., Rao, G. V., & Reddy, D. N. (2005) · PubMed · Cited by 24 · see citing works
Rome IV Multidimensional Clinical Profile
(2016) · The Rome Foundation eBooks · doi:10.24890/mdcp · Cited by 13 · see citing works
Kane, J. S., Irvine, A. J., Derwa, Y. H., Rotimi, O., & Ford, A. C. (2018) · Therapeutic Advances in Gastroenterology · doi:10.1177/1756284818783600 · Cited by 12 · see citing works
Self-citationSood, R., Gracie, D. J., Gold, M. J., To, N., Pinto-Sánchez, M. I., Berčík, P., Moayyedi, P., Ford, A. C., & Law, G. R. (2017) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.13949 · Cited by 11 · see citing works
Self-citationReducing the Need for Random Colonic Biopsies in Patients With Diarrhea
Kane, J. S., Bryan, H., & Ford, A. C. (2015) · The American Journal of Gastroenterology · doi:10.1038/ajg.2014.401 · Cited by 5 · see citing works
Self-citationAmeen, V. Z., Patterson, M. H., Colopy, M. W., et al. (2001) · Gastroenterology · doi:10.1016/s0016-5085(08)83155-1 · Cited by 1 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [13]13. Drossman DA, Thompson WG, Talley NJ. Identification of sub-groups of functional gastrointestinal disorders. Gastroenterology Intl. 1990;3:159-72.
Cited by
Sorted by citations
British Society of Gastroenterology guidelines on the management of irritable bowel syndrome
Vasant, D. H., Paine, P. A., Black, C. J., Houghton, L. A., Everitt, H. A., Corsetti, M., Agrawal, A., Aziz, I., Farmer, A. D., Eugenicos, M. P., et al. (2021) · Gut · doi:10.1136/gutjnl-2021-324598 · Cited by 547 · see citing works
Self-citationAn evidence-based update on the diagnosis and management of irritable bowel syndrome
Black, C. J., & Ford, A. C. (2025) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2025.2455586 · Cited by 27 · see citing works
Self-citation
- Authors
- Black, C. J., Craig, O., Gracie, D. J., & Ford, A. C.
- Affiliations
- University of Leeds (GB)
- Leeds Teaching Hospitals NHS Trust (GB)
- Corresponding author
- Ford, Alexander C
- Venue
- Gut
- Publisher
- BMJ
- Published
- 2020-09-24
- Volume
- 70
- Issue
- 6
- Pages
- 1110-1116
- ISSN
- 0017-5749 (ISSN-L)
- 1468-3288
- OpenAlex
- W3089239219
- Cited by
- 86
- References
- 55
- Citations by year
- 2026: 10 · 2025: 12 · 2024: 14 · 2023: 10 · 2022: 21 · 2021: 15 · 2020: 2
- FWCI
- 10.42
- Type
- journal article
- Language
- en
- Open access
- Locations
- Gut (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Health Professions › Pharmacy › Infant Health and Development
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Keywords
- irritable bowel syndrome, Rome IV criteria, Rome III criteria, diagnostic criteria validation, diagnostic accuracy, sensitivity and specificity, likelihood ratios, irritable bowel syndrome with constipation, mood symptoms, extraintestinal manifestations
- MeSH terms
- Adult, Constipation, Diarrhea, Female, Humans, Male, Middle Aged, Sensitivity and Specificity, Abdominal Pain, Likelihood Functions, Irritable Bowel Syndrome, Secondary Care, Secondary Health Care, Symptom Assessment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
