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Chapter 2 32 Abstract Introduction The Rome criteria for irritable bowel syndrome (IBS) have been revised and are expected to apply only to the subset of Rome III IBS subjects with abdominal pain as predominant symptom, occurring at least once a week. The aim of this study was to determine the percentage of Rome III IBS subjects that fulfills Rome IV criteria and to evaluate differences between Rome IV-positive and -negative subjects. Methods 404 Rome III IBS subjects completed a 14-day end-of-day symptom diary, the gastrointestinal symptom rating scale (GSRS), hospital anxiety and depression scale (HADS) and rand 36-item short-form health survey (SF-36). Diary-based surrogate Rome IV criteria were defined as occurrence of abdominal pain at least one day each week with a severity of ≥2 ( mild ; definition 1) or ≥3 ( considerable ; definition 2). Results Using surrogate Rome IV criteria, 353 (87.4%, definition 1) and 249 (61.6%, definition 2) subjects were defined as Rome IV-positive. These patients were more often female, younger and recruited from secondary/tertiary care compared to Rome IV-negative subjects. They also presented with higher abdominal pain scores and gastrointestinal (GI) symptom severity on both end-of-day diary and GSRS, higher psychological symptom scores and lower quality of life compared to Rome IV-negative subjects. Conclusions The Rome IV IBS population likely reflects a subgroup of Rome III IBS patients with more severe GI symptomatology, psychological comorbidities and lower quality of life. This implies that results from Rome III IBS studies may not be directly comparable to those from Rome IV IBS populations.