The gold standard symptom-based criteria for diagnosis of irritable bowel syndrome (IBS) are the Rome IV criteria. These are more restrictive than their predecessor, Rome III, because the cardinal feature required to meet criteria for IBS was changed to presence of abdominal pain alone, rather than abdominal pain or discomfort. This change was made because discomfort was believed to be an ambiguous term, with no equivalent in some languages. In addition, symptom frequency required for the presence of abdominal pain was increased to 1 day per week from 2 to 3 days per month. This has led to reduced sensitivity for detecting IBS and a 50% decrease in the prevalence of the disorder in the community. In a cross-sectional survey applying both Rome IV and III criteria to people living with IBS, 89% of those with Rome III–defined IBS not meeting Rome IV criteria did not meet Rome IV criteria because of this change in pain frequency. Previous iterations of the Rome criteria have performed only modestly in predicting a diagnosis of IBS. However, in a validation study, the Rome IV criteria outperformed Rome III, largely because their more restrictive nature made them more specific than Rome III. We assessed whether modifications to the Rome IV criteria led to a better trade-off between sensitivity and specificity.

中文翻译：

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评估肠易激综合征罗马 IV 标准修改后的诊断性能

诊断肠易激综合征（IBS）的基于症状的金标准是罗马 IV 标准。这些比其前身罗马 III 更具限制性，因为满足 IBS 标准所需的主要特征已更改为仅出现腹痛，而不是腹痛或不适。做出这一改变是因为“不适”被认为是一个含糊不清的术语，在某些语言中没有对应的术语。此外，出现腹痛所需的症状频率从每月 2 至 3 天增加到每周 1 天。这导致检测 IBS 的敏感性降低，并且社区中该疾病的患病率降低了 50%。在一项对 IBS 患者应用罗马 IV 和 III 标准的横断面调查中，由于疼痛频率的变化，在不符合罗马 IV 标准的罗马 III 定义的 IBS 患者中，89% 不符合罗马 IV 标准。之前的罗马标准迭代在预测 IBS 诊断方面表现不佳。然而，在验证研究中，罗马 IV 标准优于罗马 III，主要是因为它们更具限制性，使其比罗马 III 更具体。我们评估了对罗马 IV 标准的修改是否会导致敏感性和特异性之间更好的权衡。