Prevalence and impact of Rome IV versus Rome III irritable bowel syndrome in patients with inflammatory bowel disease

Neurogastroenterol Motil. 2022 May;34(5):e14256. doi: 10.1111/nmo.14256. Epub 2021 Sep 1.


Background: Irritable bowel syndrome (IBS)-type symptoms are common in inflammatory bowel disease (IBD), but few studies have examined the prevalence and impact of IBS-type symptoms in IBD according to Rome IV criteria.

Methods: We collected demographic, symptom (Rome III, Rome IV, and clinical disease activity indices), psychological (anxiety, depression, and somatization), and quality of life data from 973 IBD patients. Medical records were reviewed to document disease type, extent/location, behavior, medical therapy, and antidepressant or opioid use. We compared characteristics of individuals with no IBS-type symptoms, Rome III IBS-type symptoms, and Rome IV IBS-type symptoms.

Key results: In total, 302 (31.0%) patients met the Rome III criteria for IBS, and 172 (17.7%) met Rome IV criteria. Those with IBS-type symptoms were younger, more likely to be female, and had higher rates of antidepressant (p = 0.006) or opioid use (p = 0.001). Rome IV IBS-type symptoms were associated with symptoms of mood disorders, flare of disease activity, and lower quality of life scores (p < 0.001 for all analyses). Compared with Rome III criteria, those with Rome IV IBS-type symptoms had significantly higher rates of anxiety (p < 0.001), depression (p = 0.002), and somatization (p < 0.001), lower quality of life scores (p < 0.001) and were more likely to have CD (p = 0.011), with ileal distribution (p = 0.006).

Conclusions and inferences: Rome IV IBS-type symptoms are associated with increased psychological co-morbidity, lower quality of life scores, and higher rates of antidepressant or opioid use. This is a cohort potentially at risk of adverse clinical outcomes and should be a focus for future research.

Keywords: Rome III; Rome IV; anxiety; characterization; depression.

MeSH terms

  • Analgesics, Opioid
  • Chronic Disease
  • Female
  • Humans
  • Inflammatory Bowel Diseases* / complications
  • Inflammatory Bowel Diseases* / epidemiology
  • Irritable Bowel Syndrome* / complications
  • Irritable Bowel Syndrome* / diagnosis
  • Irritable Bowel Syndrome* / epidemiology
  • Male
  • Prevalence
  • Quality of Life
  • Rome
  • Surveys and Questionnaires


  • Analgesics, Opioid