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Chapter 1 10 Alarm features for IBS* 1. Blood in the stools, unless caused by fissures or hemorrhoids 2. Onset of symptoms after 50 years of age 3. Fever 4. Unintended weight loss 5. Nocturnal symptoms 6. Family history of coeliac disease, inflammatory bowel disease, or colon cancer 7. Abdominal mass 8. Appetite loss 9. Ascites 10. Anemia Box 1.1 Alarm features for IBS, presence of any of the following symptoms may warrant further investigation. Since 1978, several criteria have been described to aid diagnostic accuracy of IBS both in research and clinical setting. 21 The Rome III diagnostic criteria ( Box 1.2 ) were released in 2006 2 and were, until recently, the golden standard to diagnose IBS with an estimated sensitivity and specificity of 69.6% and 82.0%, respectively. 22 Rome III diagnostic criteria 2 for IBS* Recurrent abdominal pain or discomfort, on average: At least 3 days per month in the last 3 months Associated with 2 or more of the following: 1. Improvement with defecation 2. Onset associated with a change in frequency of stool 3. Onset associated with a change in form (appearance of stool) *Onset of symptoms at least 6 months prior to diagnosis Box 1.2 Rome III diagnostic criteria for IBS, published in 2006. In 2016, the Rome IV criteria ( Box 1.3. ) have been published 1 and have an estimated sensitivity and specificity of 62.7% and 97.1%, respectively. 23 The Rome IV criteria comprise two main updates when compared to Rome III: 1) The term abdominal discomfort has been removed, leaving the presence of abdominal pain the key requirement for IBS; 2) The frequency threshold of symptoms has been increased to at least 1 day per week.