Irritable bowel syndrome and the Rome III criteria: for better or for worse?

The paper by Sperber et al. in this issue is an early evaluation of the Rome III criteria against the Rome II criteria for irritable bowel syndrome that throws up several important observations. A three to four-fold increase was observed in irritable bowel syndrome prevalence with the Rome III criteria. Individuals with the Rome II criteria had more doctor visits, perception of stress and a negative global feeling. There could be a shift of individuals between irritable bowel syndrome and other functional bowel disorder diagnostic groups such as functional constipation and functional bloating. In this review, it is suggested that rigid application of the symptom frequency and duration requirements of the older Rome criteria could have introduced a selection bias for patients with greater psychological disturbance, and that this could have impacted negatively on our perception and management of irritable bowel syndrome. The findings of Sperber et al. suggest that the new Rome III criteria may enable us to pay more attention to the average irritable bowel syndrome patient we see in our clinics as opposed to the chronically severe patient. It is proposed that improved management of our average patient may translate into better outcomes in terms of reduction in specialist referral, unnecessary surgery and potentially harmful alternative treatments.