A sequence of consensus‐based Rome criteria for irritable bowel syndrome (IBS) has been published since 1989. The fundamental definition based on abdominal pain in association with bowel dysfunction has been consistent. However, two major changes occurred in the Rome II and IV criteria. The former change involved “splitting off” of symptoms that were not consistently associated with pain, such as functional, constipation, diarrhea, and bloating. In Rome IV, the main changes were the exclusion of discomfort (in contrast to pain) and the more stringent frequency criteria for the pain to be eligible for diagnosis of IBS (specifically, on average, at least 1 day per week in the last 3 months). Validation studies of the consensus, symptom‐based criteria have identified multiple deficiencies that question the rationale for “splitting” the different syndromes, and favor a simpler identification of the classical symptoms of abdominal pain, bowel dysfunction, and bloating, and exclusion of alarm symptoms. Advances in the identification of actionable biomarkers related to the symptoms suggestive of functional gastrointestinal disorders have the potential to usher a change in practice from positive diagnosis of symptom complexes followed by empirical treatment to identification of the mechanisms causing the symptoms and targeted therapy.

中文翻译：

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肠易激综合征：从罗马标准中找准道路。

自 1989 年以来，一系列基于共识的肠易激综合征 (IBS) 罗马标准已经发布。基于腹痛与肠功能障碍相关的基本定义一直是一致的。然而，罗马 II 和 IV 标准发生了两个重大变化。前一种变化涉及“分离”与疼痛不一致的症状，例如功能性、便秘、腹泻和腹胀。在罗马 IV 中，主要变化是排除了不适（与疼痛相反）和更严格的疼痛频率标准有资格诊断 IBS（具体而言，在过去 3 年中平均每周至少 1 天）个月）。共识的验证研究，基于症状的标准已经确定了多个缺陷，质疑“分裂”不同综合征的基本原理，并支持更简单地识别腹痛、肠功能障碍和腹胀等经典症状，并排除警报症状。识别与提示功能性胃肠道疾病症状相关的可操作生物标志物的进展有可能在实践中带来改变，从症状复合体的阳性诊断然后经验性治疗到识别导致症状的机制和靶向治疗。