Impact of Rome IV criteria on the prevalence of post-infection irritable bowel syndrome

Neurogastroenterol Motil. 2023 May;35(5):e14532. doi: 10.1111/nmo.14532. Epub 2023 Jan 12.


Margaret Breen-Lyles 1Marijke Decuir 2Anjali Byale 1Kirk Smith 2Madhusudan Grover 1


Author information

1Department of Gastroenterology and Hepatology, Enteric Neuroscience Program, Mayo Clinic, Rochester, Minnesota, USA.

2Minnesota Department of Health, St. Paul, Minnesota, USA.


Background: The Rome IV irritable bowel syndrome (IBS) criteria include changes to the description and frequency of abdominal pain. Existing studies have demonstrated a lower prevalence and greater severity in IBS patients identified using Rome IV than Rome III criteria. Our aim was to investigate the prevalence of post-infection IBS (PI-IBS) using Rome IV criteria in a population-based cohort of laboratory-confirmed C. jejuni infection cases.

Methods: The Minnesota Department of Health (MDH) requires notification of Campylobacter cases and interviews patients to gather information on clinical symptoms. For this study, the Rome IV diagnostic questionnaire was utilized 6-9 months after infection to determine the development of PI-IBS. The survey responses were analyzed for the prevalence of IBS and symptom severity.

Key results: Surveys were completed by 391 participants (31% response rate). Twenty-three patients had pre-existing IBS, and 18 did not complete enough questions to categorize their case status. Of the 350 remaining participants, 58 (17%) met Rome IV criteria. An additional 47 patients would have met the Rome III IBS criteria for pain frequency, driving the cumulative prevalence to 30%. The mean IBS Symptom Severity Score (IBS-SSS) in Rome IV patients was significantly higher than in Rome III (p < 0.05). With Rome IV, IBS-diarrhea was the most common subtype.

Conclusions & inferences: Rome IV criteria resulted in a 19% lower prevalence of PI-IBS than earlier reported Rome III-based prevalence in a similar population. Rome IV defined PI-IBS patients have greater symptom severity but similar distribution of IBS subtypes.

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