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Chapter 2 34 Rome III IBS 1) Recurrent abdominal pain or discomfort* at least 3 days per month in the last 3 months and associated with 2 or more of the following: a. Improvement with defecation; b. Onset associated with a change in frequency of stool; c. Onset associated with a change in form (appearance) of stool. 2) Criteria fulfilled for the last 3 months with symptom onset at least 6 months prior to diagnosis. * Discomfort means an uncomfortable sensation not described as pain. Rome IV IBS 1) Recurrent abdominal pain, on average, at least 1 day per week in the last 3 months and associated with 2 or more of the following: a. Related to defecation; b. Associated with a change in frequency of stool; c. Associated with a change in form (appearance) of stool. 2) Criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis. Box 2.1 Definition of IBS according to Rome III and Rome IV criteria. Rome criteria are widely used as a cornerstone for inclusion in IBS clinical trials and cohort studies. It is expected that in future studies only a subset of Rome III IBS patients, i.e. those with more severe abdominal pain, will be eligible for study participation by introducing Rome IV criteria. In order to generalize current data to Rome IV populations and to compare results from Rome III and Rome IV studies, it is important to evaluate which Rome III patients are likely to meet the Rome IV criteria. Therefore, the aim of this study was to determine the percentage of Rome III-positive IBS subjects that is also highly likely to fulfill Rome IV criteria, based on end-of-day symptom diaries, and to evaluate whether demographical, clinical and psychosocial differences exist between Rome IV-positive and Rome IV-negative subjects, in a well-defined Rome III IBS population. Materials and methods Study design In the current analyses, data from a well-phenotyped Dutch cohort study, the Maastricht IBS (MIBS) Cohort, on the phenotypical and genotypical characterization of IBS patients 14-16 , were evaluated. The study protocol has been approved by the Maastricht University Medical Center + (Maastricht UMC+) Committee of Ethics in