Pubmed-Epidemiological, Clinical, and Psychological Characteristics of Individuals with Self-reported Irritable Bowel Syndrome Based on the Rome V versus Rome IV Criteria

Clin Gastroenterol Hepatol. 2026 Jul 30:S1542-3565(26)00563-X. doi: 10.1016/j.cgh.2026.07.022. Online ahead of print.

ABSTRACT

BACKGROUND & AIMS: The Rome V process altered diagnostic criteria for irritable bowel syndrome (IBS) compared with Rome IV, by modifying the requirement for frequency and persistence of symptoms. We compared epidemiological, clinical, and psychological characteristics of people with Rome V-defined IBS, versus Rome III or IV, in the community.

METHODS: We conducted a survey of adults in the United Kingdom with self-reported IBS. Participants completed validated questionnaires assessing Rome III, IV, and V criteria, gastrointestinal symptom severity, quality of life, and psychological comorbidity. Proportions of people meeting criteria for IBS were compared across definitions, including a sensitivity analysis related to exclusion of individuals with continuous pain from the Rome V definition of IBS. Agreement between the various criteria was evaluated using a Kappa statistic. Characteristics of those meeting the three iterations of the criteria, and stability of the criteria during longitudinal follow-up, were compared.

RESULTS: In the main analysis, excluding those who reported continuous abdominal pain on every day of the week from the Rome V definition of IBS, among 1,275 respondents with complete data, 995 (78.0%) met Rome III, 752 (59.0%) Rome IV, and 893 (70.0%) Rome V criteria for IBS. Agreement between Rome V criteria and Rome III or Rome IV criteria was substantial to fair (Kappa = 0.75 and 0.40, respectively). Compared with individuals meeting Rome IV criteria, those meeting Rome V criteria reported significantly lower symptom severity, less psychological comorbidity, a reduced impact on ability to work and participate in social activities, and higher quality of life scores. Rome V IBS was less stable than Rome IV IBS during longitudinal follow-up.

CONCLUSIONS: Applying the Rome V criteria changes the population classified as having IBS, mainly due to the exclusion of those with continuous pain, identifying a clinically less severe cohort. This may have implications for research and clinical practice.

PMID:42532244 | DOI:10.1016/j.cgh.2026.07.022