IBS — irritable bowel syndrome
Structured Rome V assessment for IBS. We combine positive symptom diagnostics with targeted red-flag screening and organic exclusion — before we build an individual dietary and pharmacological plan. Everything happens in the clinic.
Interactive tool
Diagnostic flow
Answer 4 simple steps and get your personal Rome V-based IBS plan. Guidance only; does not replace a consultation.
- 1 Rome V
- 2 Bristol
- 3 Red flags
- 4 Treatment
Step 1 - How is your abdominal pain?
We check whether your situation fits the Rome V definition of IBS.
What is IBS?
Irritable bowel syndrome (IBS) is a disorder of gut-brain interaction (DGBI) — a condition defined by symptoms rather than by a visible lesion. IBS affects around 10 % of the population globally and typically presents with recurrent abdominal pain linked to bowel habits, bloating and altered stool form or frequency. Modern gastroenterology treats IBS as a positive diagnosis based on the Rome V criteria — not a diagnosis of exclusion, but paired with structured screening for organic disease.
Rome V criteria
Recurrent abdominal pain on average ≥ 1 day per week for the past 3 months, associated with 2 or more of:
- Related to defecation
- Associated with a change in stool frequency
- Associated with a change in stool form (appearance)
Symptoms must have started at least 6 months before diagnosis.
Subtypes (Bristol Stool Chart)
- IBS-C (constipation-predominant) — > 25 % of stools are Bristol 1–2 (hard/lumpy)
- IBS-D (diarrhoea-predominant) — > 25 % of stools are Bristol 6–7 (loose/watery)
- IBS-M (mixed) — > 25 % of both types
- IBS-U (unclassified) — insufficient abnormality of stool consistency to meet C, D or M
Red-flag screening
Red flags trigger targeted investigation before an IBS label is applied — because they raise the probability of inflammatory bowel disease, malignancy or another organic cause.
- Age of onset > 50 years
- Rectal bleeding or melaena
- Unintentional weight loss > 5 % in 6 months
- Iron-deficiency anaemia
- Nocturnal symptoms disturbing sleep
- Family history of colorectal cancer, IBD or coeliac disease
- Palpable abdominal or rectal mass
Diagnostic assessment
- Faecal calprotectin — differentiates IBS from IBD. < 50 μg/g rules out active inflammation in most cases.
- Blood tests — full blood count, CRP, TSH, ferritin, coeliac serology (anti-tTG IgA).
- Colonoscopy — if red flags, calprotectin elevated, or age > 50.
- Gastroscopy — if upper GI symptoms or suspicion of coeliac disease.
- SIBO breath test — considered when bloating dominates or if conventional treatment has failed (30–60 % overlap).
Treatment — a stepped plan
Diet and lifestyle (first line)
- Low-FODMAP diet — structured 4–6 week elimination phase followed by systematic reintroduction to identify individual triggers. Ideally with a trained dietitian.
- Regular meals, adequate hydration, limiting caffeine and alcohol
- Regular physical activity and structured sleep
- Stress management — mindfulness, CBT and gut-directed hypnotherapy have evidence in IBS
Pharmacotherapy (subtype-specific)
- IBS-D: loperamide, rifaximin (particularly with SIBO), bile-acid sequestrants when bile-acid diarrhoea is suspected
- IBS-C: soluble fibre (psyllium), PEG (macrogol), linaclotide for refractory cases
- Pain / cramps: antispasmodics (mebeverine, peppermint oil), low-dose TCA (amitriptyline 10–25 mg) as a neuromodulator
- Comorbid anxiety/depression: SSRI/SNRI — often improves overall symptom burden
Follow-up
Reassessment after 4–6 weeks. Diet, medication and any comorbid conditions are adjusted iteratively. Persistent or worsening symptoms — or emergent red flags — prompt renewed investigation.