Comparison of demographic, clinical, and psychological characteristics among patients with irritable bowel syndrome meeting the Rome clinical, Rome V, and Rome IV criteria.

Abstract

The Rome clinical criteria for irritable bowel syndrome (IBS) were introduced to improve clinical applicability and represent an important advancement within the Rome V process. However, their clinical profiles relative to the standard Rome criteria remain unclear. Consecutive adults with suspected IBS were prospectively recruited at a tertiary outpatient clinic in China. Participants completed symptom questionnaires and underwent clinical investigations to exclude organic disease. Patients were classified into three mutually exclusive groups: meeting Rome clinical criteria only, meeting Rome V only, and meeting Rome IV. We examined diagnostic discordance and compared demographic, clinical, and psychological characteristics across the three groups. Among 685 participants with suspected IBS, 533 (77.8%) met the Rome clinical criteria, 443 (64.7%) met Rome V, and 238 (34.7%) met Rome IV. The Rome IV criteria missed nearly half (46.3%) of Rome V-defined patients. Of those identified by the Rome clinical criteria, 90 (20.3%) were not captured by the Rome V criteria, primarily due to insufficient symptom duration (51.1%) and inadequate symptom frequency (48.9%). These missed patients showed gastrointestinal symptom severity, psychological burden (gastrointestinal-specific anxiety, somatic symptoms, and perceived stress), quality of life impairment, and healthcare utilization comparable to those meeting Rome V only, while both groups were less severe than Rome IV-defined patients (P < 0.001). The Rome clinical criteria identify a clinically meaningful IBS population, with approximately one in five individuals missed by the Rome V criteria. These patients have a disease burden comparable to those meeting the Rome V criteria only.