The Con Argument

Some claim that symptom-based Rome criteria are diagnostic and enhance clinical practice and choice of therapy for patients presenting with gastrointestinal symptoms. This overview focuses on lower gastrointestinal symptoms: constipation, diarrhea, pain, and bloating. The main con arguments for using such criteria for diagnosis are insufficient specificity, overlap of symptom-based categories or disorders, insufficient and therefore nonspecific characterization of pain in the criteria, inability to differentiate the “mimics” of irritable bowel syndrome (IBS) with constipation (IBS-C) and IBS with diarrhea (IBS-D), and inability to optimize treatment for IBS with mixed or alternating bowel function (IBS-M) or bloating in the absence of objective measurements.

Abbreviations used in this paper: BAM, bile acid malabsorption, BM, bowel movements, FC, functional constipation, FDD, functional defecation disorders, FGID, functional gastrointestinal disorders, IBS, irritable bowel syndrome, IBS-C, irritable bowel syndrome with constipation, IBS-D, irritable bowel syndrome with diarrhea