Black CJ, Craig O, Gracie DJ, et al. - The performance of the Rome IV criteria for the diagnosis of IBS was examined in secondary care. In addition, these were compared with the previous iteration, the Rome III criteria. Researchers retrieved complete symptom data from adult patients with suspected IBS referred to a single UK clinic. To confirm IBS, the reference standard used was the presence of lower abdominal pain or discomfort in correlation with changed stool form or frequency, in a patient with no evidence of organic gastrointestinal disease after investigation. A good level of agreement was observed between the Rome IV and Rome III criteria. Compared with the reference standard, the Rome IV criteria had sensitivity and specificity of 82.4% and 82.9%, respectively, in 572 patients (431 (75.3%) women, mean age 36.5 years). The Rome III criteria showed sensitivity and specificity of 85.8% and 65.0% in 471 patients (350 (74.3%) women, mean age 36.7 years), compared with the reference standard. Findings indicated significantly better performance of the Rome IV criteria than the Rome III criteria in diagnosing IBS, although uncertainty remains concerning its clinical relevance.