394 Irritable Bowel Syndrome
habit (Latimer, 1983). These two symptoms needed to be
present much of the time for at least three months in order to
ful“ll the criteria, and a series of medical tests were necessary
to rule out in”ammatory bowel disease (IBD), lactose
intolerance/malabsorption, intestinal parasites, and other GI
diseases (Latimer, 1983). There were two main problems
with this criterion. First, the de“nition of IBS was residual,
and, second, as we began to better understand the IBS patient
and her symptoms, we realized that, in addition to abdominal
pain and altered bowel habits, IBS patients often experience
other problematic symptoms that were not considered in the
•Clinical Criteria.Ž These included bloating, ”atulence,
belching, and borborygmi (noticeable bowel sounds).
Manning Criteria
Later, as the GI community became more aware of the prob-
lems associated with a diagnosis by exclusion, Manning
et al. (1978) attempted to re“ne the Clinical Criteria by ad-
ministering a questionnaire to 109 patients complaining of
abdominal pain, constipation, or diarrhea. The questionnaire
addressed the frequency of 15 GI symptoms during the past
year. About two years later, chart notes were reviewed to ar-
rive at a de“nitive diagnosis for each of the patients. Seventy-
nine cases were analyzed (32 patients with IBS, 33 patients
with organic disease, and 14 patients with diverticular dis-
ease who were excluded). Manning and colleagues (1978)
found that the four symptoms that best discriminated
(p .01 or better) between IBS and organic disease were:
(a) looser stools at onset of pain; (b) more frequent bowel
movements at onset of pain; (c) pain that eased after a bowel
movement; and (d) visible distention (bloating). In addition,
trends were observed for feelings of distention, mucus per
rectum, and the feeling (often) of incomplete emptying.
However, because there are no pathognomonic symptoms of
IBS (symptoms which occur only in IBS and no other disor-
der), and there were many false positives (8/30; 26.7%) and
false negatives (6/31; 19.4%), these discriminators could not
be considered completely reliable for the diagnosis of IBS.
Next, Manning and colleagues (1978) attempted to deter-
mine whether the presence of two or moreof the aforemen-
tioned symptoms improved the ability to discriminate
between IBS and organic GI disease, “nding that when one
endorsedthree or moresymptoms, 27 of 32 (84%) IBS
patients were correctly identi“ed, and 25 of 33 (76%) with
organic disease were correctly identi“ed. However, this still
leaves a false positive rate of 24% (those with organic disease
being diagnosed with IBS), which is an uncomfortable mar-
gin of error. A larger study evaluating the Manning criteria re-
ported similar results (Talley et al., 1986).
Rome CriteriaIn the late 1980s, the international gastroenterology commu-
nity again attempted to rede“ne the criteria for IBS. After the
Thirteenth International Congress of Gastroenterology (held
in Rome, Italy, in 1988), Drossman, Thompson, et al. (1990)
produced the “rst published report that proposed what is
known as the Rome Criteria. Later, Thompson, Creed,
Drossman, Heaton, and Mazzacca (1992) further de“ned all
functional bowel disorders, and included IBS as their most
prominent example.
The Rome Criteria were developed using a factor analysis
of 23 symptoms that included the former Manning and Clin-
ical criteria. The “rst sample were 351 women visiting
Planned Parenthood clinics and 149 women recruited from
church women•s societies (Whitehead, Crowell, Bosmajian,
et al., 1990). A second sample consisted of university psy-
chology students. Analysis of these two samples revealed that
in females, (Whites and African Americans), clustering of the
three primary symptoms (excluding bloating) occurred. Sim-
ilarly, in males, clustering of all four symptoms occurred,
with bloating loading least strongly (Taub, Cuevas, Cook,
Crowell, & Whitehead, 1995). Thus, three symptoms were
chosen to make up the “rst part of the Rome I criteria. These
include at least three months of continuous or recurrent
symptoms of:1.Abdominal pain or discomfort which is:
(a) Relieved with defecation,
(b) Associated with a change in stool frequency, and/or
(c) Associated with a change in consistency of stool.
2.Two or more of the following, at least a quarter of occa-
sions or days:
(a) Altered stool frequency (more than three bowel move-
ments a day or fewer than three bowel movements a
week),
(b) Altered stool form (lumpy/hard or loose/watery),
(c) Altered stool passage (straining, urgency, or feeling of
incomplete evacuation),
(d) Passage of mucous, and/or
(e) Bloating or feeling of abdominal distention.
3.Absence of historical, physical, and medical “ndings of
organic disease or pathology.One of the criticisms of the Rome Criteria has been that
the de“nition lacks symptoms such as ur gency, abdominal
pain, or diarrhea in the postprandial period (Camilleri &
Choi, 1997). Another common concern is whether the crite-
ria•s requirement of both abdominal pain and chronic