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Diagnosis of IBS: symptoms, symptom-based criteria, biomarkers or 'psychomarkers'?

Key Points

  • The prevalence of IBS is as high as 20%, with an estimated incidence of 1–2% per year in community samples in Western populations; direct and indirect costs related to IBS are high

  • Individual symptom items taken from the clinical history perform poorly in predicting IBS

  • Symptom-based diagnostic criteria perform only modestly in predicting IBS, with the current gold standard, the Rome III criteria, performing no better than previous recommended symptom-based criteria

  • Biomarkers, with the potential exception of faecal volatile organic molecules and possibly colonic mucosal immune cells, have been disappointing in terms of their performance in diagnosing IBS accurately

  • Combining clinical markers with biomarkers and psychological markers (so-called psychomarkers) could improve our ability to distinguish between IBS and organic disease, but at the cost of increasing complexity

  • Latent class analysis to improve the predictive power of methods used to diagnose IBS, and to discriminate between IBS and non-IBS symptom profiles, might represent a future area of development


IBS is estimated to have a prevalence of up to 20% in Western populations and results in substantial costs to health-care services worldwide, estimated to be US$1 billion per year in the USA. IBS remains difficult to diagnose due to its multifactorial aetiology, heterogeneous nature and overlap of symptoms with organic pathologies, such as coeliac disease and IBD. As a result, IBS often continues to be a diagnosis of exclusion, resulting in unnecessary investigations. Available methods for the diagnosis of IBS—including the current gold standard, the Rome III criteria—perform only moderately well. Visceral hypersensitivity and altered pain perception do not discriminate between IBS and other functional gastrointestinal diseases or health with any great accuracy. Attention has now turned to developing novel biomarkers and using psychological markers (so-called psychomarkers) to aid the diagnosis of IBS. This Review describes how useful symptoms, symptom-based criteria, biomarkers and psychomarkers, and indeed combinations of all these approaches, are in the diagnosis of IBS. Future directions in diagnosing IBS could include combining demographic data, gastrointestinal symptoms, biomarkers and psychomarkers using statistical methods. Latent class analysis to distinguish between IBS and non-IBS symptom profiles might also represent a promising avenue for future research.

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Figure 1: Potential aetiological mechanisms developed as a diagnostic test for IBS.


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All authors contributed equally to all aspects of this manuscript.

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Correspondence to Alexander C. Ford.

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Sood, R., Law, G. & Ford, A. Diagnosis of IBS: symptoms, symptom-based criteria, biomarkers or 'psychomarkers'?. Nat Rev Gastroenterol Hepatol 11, 683–691 (2014).

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