Table 1.

Comparison of symptom-based criteria

Criteria/y	Symptoms, signs, and laboratory investigations included in criteria	Symptom duration required	Diagnostic performance
Manning et al39 1978	Abdominal pain relieved by defecation; more frequent stools with onset of pain; looser stools with onset of pain; passage of mucus per rectum; feeling of incomplete emptying; patient-reported visible abdominal distension	None	Sensitivity 78%, specificity 72%, positive LR 2.9 (95% CI, 1.3–6.4)31
Kruis et al40 1984	Symptoms (reported by patient using a form): abdominal pain, flatulence, or bowel irregularity; description of abdominal pain as burning, cutting, very strong, terrible, feeling of pressure, dull, boring, or “not so bad”	>2 yr	Sensitivity 77%, specificity 89%, positive LR 8.6 (95% CI, 2.9–26.0)31
	Signs (determined by physician): abnormal physical findings and/or history; pathognomonic for any diagnosis other than IBS; ESR >20 mm/2 h; leukocytosis >10,000 cells/μL; anemia (hemoglobin <12 g/dL for women, <14 g/dL for men); physician impression is that patient’s history suggests blood in the stools
Rome I criteria41 1990	Abdominal pain or discomfort relieved with defecation or associated with a change in stool frequency or consistency; any variation in defecation on ≥25% of occasions evidenced by 3 of the following: Altered stool frequency Altered stool form Altered stool passage Passage of mucus per rectum Bloating or distension	≥3 mo	Sensitivity 65%, specificity 100%, PPV 100%43
Rome II criteria13,42 1999	Abdominal discomfort or pain that has 2 of 3 features: Relieved with defecation Onset associated with a change in stool frequency Onset associated with a change in stool form	≥12 wk (need not be consecutive in past year)	Not validated
Rome III criteria1 2006	Recurrent abdominal pain or discomfort ≥3 d/mo in the past 3 mo associated with ≥2 of the following: Improvement with defecation Onset associated with a change in stool frequency Onset associated with a change in stool form	Symptom onset: ≥6 mo before diagnosis	Not validated

Adapted with permission from Ford AC, Talley NJ, Veldhuyzen van Zanten SJ, Vakil NB, Simel DL, Moayyedi P. Will the history and physical examination help establish that irritable bowel syndrome is causing this patient’s lower gastrointestinal tract symptoms? JAMA. 2008;300(15):1793–1805.31 Copyright © 2008 American Medical Association. All rights reserved.

Abbreviations: Cl, confidence interval; LR, logistic regression; IBS, irritable bowel syndrome; ESR, erythrocyte sedimentation rate; PPV, positive predictive value.