The Rome V criteria for the diagnosis of irritable bowel syndrome in secondary care: a diagnostic accuracy study: GI Signals

Motility prospective cohort · n=726 · Jul 2, 2026 · Lancet GH · IF 30.9

The Rome V criteria for the diagnosis of irritable bowel syndrome in secondary care: a diagnostic accuracy study.

New evidenceIBS

Clinical takeawayRome V criteria show lower sensitivity (66.1%) compared to Rome IV (78.9%) and Rome III (87.5%) in this secondary care study. No clinical action yet; await further validation and SOC updates.

What it foundRome V criteria for IBS had sensitivity of 66.1% (95% CI 62.1-69.9) and specificity of 80.1% (72.4-86.5), identifying a different patient group compared to Rome IV (sensitivity 78.9%, specificity 81.0%) and Rome III (sensitivity 87.5%, specificity 75.0%).

ContextRome V shifts diagnostic balance versus Rome IV (higher specificity, lower sensitivity) and Rome III (higher specificity, much lower sensitivity). This challenges prior reliance on Rome criteria alone for case identification in referrals.

Reinforcessuggested applicable standard· American College of Gastroenterology, 'ACG Clinical Guideline: Management of Irritable Bowel Syndrome', 2021

Decision at stakethe use of Rome IV criteria for IBS diagnosis

No single passage of this standard matched the paper closely enough to quote, so none is shown. The standard is cited above.

Our full summary of this standard

Diagnosis: use a positive diagnostic strategy based on Rome IV criteria rather than a strategy of exclusion (strong for cost-effectiveness, high quality; consensus for time-to-therapy), and categorize by IBS subtype (consensus). In patients with IBS and diarrhea symptoms: check celiac serology (strong, moderate) and, in those WITHOUT alarm features, fecal calprotectin (or fecal lactoferrin) plus CRP to rule out IBD (strong; moderate quality for CRP/calprotectin, very low for lactoferrin). Recommend AGAINST routine stool testing for enteric pathogens (conditional, low) and AGAINST routine colonoscopy in patients younger than 45 without warning signs (conditional, low). Anorectal physiology testing only when symptoms suggest a pelvic floor disorder and/or for refractory constipation not responding to standard medical therapy (consensus). Treatment, all subtypes: soluble, not insoluble, fiber (strong, moderate); a LIMITED trial of a low-FODMAP diet (conditional, very low); gut-directed psychotherapies for global symptoms (conditional, very low); TCAs for global symptoms (strong, moderate); peppermint suggested (conditional, low); antispasmodics for abdominal pain (conditional, low); AGAINST probiotics (conditional, very low), AGAINST fecal transplant (strong, very low). IBS-C: chloride channel activators (strong, moderate) and guanylate cyclase activators (strong, high); AGAINST PEG products for global IBS-C symptoms (conditional, low); tegaserod reserved for women younger than 65 with ≤1 cardiovascular risk factor who have not adequately responded to secretagogues (strong/conditional, low). IBS-D: rifaximin (strong, moderate); alosetron only for women with severe IBS-D who have failed conventional therapy (conditional, low); mixed opioid agonists/antagonists, i.e. eluxadoline (conditional, moderate); AGAINST bile acid sequestrants (conditional, very low).

American College of Gastroenterology, 'ACG Clinical Guideline: Management of Irritable Bowel Syndrome', 2021 · reviewed 2026-07-21 ↗

Staller K … Ford AC · Lancet Gastroenterology & Hepatology · IF 30.9 · PubMed ↗Permalink