IBS Diagnosis: Understanding Rome IV Criteria and the Role of Exclusion Colonoscopy in Chronic Abdominal Pain

The IBS diagnosis presents a frequent clinical challenge in medical practice, as chronic abdominal pain and changes in bowel habits are common symptoms across various pathologies. Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder characterized by recurrent abdominal pain associated with alterations in the form or frequency of bowel movements. Accurate identification of this condition is crucial to avoid unnecessary treatments and improve the patient's quality of life.

The Rome IV criteria are the most widely used diagnostic tool for IBS. These criteria focus on identifying specific symptoms, such as abdominal pain that improves with defecation and changes in the frequency or consistency of stools. However, it is essential to perform an exclusion colonoscopy to rule out organic diseases that may present similar symptoms, such as inflammatory bowel disease, celiac disease, or colorectal cancer. Excluding these conditions is fundamental to confirming an IBS diagnosis based on symptoms [1](https://doi.org/10.1016/S2468-1253(20)30212-0).

The diagnostic approach to IBS has evolved significantly. While traditionally considered a diagnosis of exclusion, current evidence suggests that a positive diagnosis based on the Rome IV criteria is more efficient and cost-effective. Clinical evaluation should include a detailed history and physical examination, along with specific tests to rule out organic diseases when alarm symptoms are present, such as unexplained weight loss, gastrointestinal bleeding, or anemia [2](https://doi.org/10.1111/apt.16597). Additionally, serological tests for celiac disease are recommended for all patients, regardless of the predominant stool form [3](https://doi.org/10.1016/j.gtc.2021.03.004).

In conclusion, the diagnosis of IBS should be based on a positive approach using the Rome IV criteria, complemented by tests to exclude organic diseases when necessary. This approach not only enhances diagnostic accuracy but also reduces the economic and emotional burden on patients. Early and accurate identification of IBS allows for better symptom management and improvement in the patient's quality of life [4](https://doi.org/10.1038/ajg.2010.56).

Referencias

• [1] The overlap between irritable bowel syndrome and organic gastrointestinal diseases.
• [2] Review article: Diagnosis and investigation of irritable bowel syndrome.
• [3] Making a Confident Diagnosis of Irritable Bowel Syndrome.
• [4] Validation of symptom-based diagnostic criteria for irritable bowel syndrome: a critical review.

Created 2/1/2025