Indian Journal of Gastroenterology

, Volume 32, Issue 6, pp 369–375 | Cite as

Comparison of Manning, Rome I, II, and III, and Asian diagnostic criteria: Report of the Multicentric Indian Irritable Bowel Syndrome (MIIBS) study

  • Uday C. Ghoshal
  • Philip Abraham
  • Shobna J. Bhatia
  • Sri Prakash Misra
  • Gourdas Choudhuri
  • K. D. Biswas
  • Karmabir Chakravartty
  • Sunil Dadhich
  • B. D. Goswami
  • V. Jayanthi
  • Sunil Kumar
  • Abraham Koshy
  • K. R. Vinay Kumar
  • Govind Makharia
  • Sandeep Nijhawan
  • Nitesh Pratap
  • Gautam Ray
  • Sanjeev Sachdeva
  • Shivaram Prasad Singh
  • Varghese Thomas
  • Harsh Udawat
Original Article



Attempts to diagnose and subtype irritable bowel syndrome (IBS) by symptom-based criteria have limitations, as these are developed in the West and might not be applicable in other populations.


This study aimed to compare different criteria for diagnosing and subtyping of IBS in India.


Manning's and the Rome I, II, and III criteria as well as the Asian criteria were applied to 1,618 patients (from 17 centers in India) with chronic lower gastrointestinal (GI) symptoms with no alarm features and negative investigations.


Of 1,618 patients (aged 37.5 [SD 12.6] years; 71.2 % male), 1,476 (91.2 %), 1,098 (67.9 %), 649 (40.1 %), 849 (52.5 %), and 1,206 (74.5 %) fulfilled Manning's, Rome I, II, and III, and the Asian criteria, respectively. The most common reason for not fulfilling the criteria was absence of the following symptoms: “more frequent stools with onset of pain,” “loose stool with onset of pain,” “relief of pain with passage of stool,” “other abdominal discomfort/bloating,” and, in a minority, not meeting the duration criterion of 3 months/12 weeks. By stool frequency, constipation-predominant IBS (<3 stools/week) was diagnosed in 319 (19.7 %), diarrhea-predominant IBS (>3 stools/day) in 43 (2.7 %), and unclassified in 1,256 (77.6 %). By Bristol stool form, constipation, diarrhea, and unclassified were diagnosed in 655 (40.5 %), 709 (43.8 %), and 254 (15.7 %) patients, respectively. By their own perception, 462 (28.6 %), 541 (33.4 %), and 452 (27.9 %) patients reported constipation-predominant, diarrhea-predominant, and alternating types, respectively.


By Manning's and the Asian criteria, a diagnosis of IBS was made frequently among Indian patients with chronic functional lower GI symptoms with no alarm features; the Rome II criteria gave the lowest yield. By the stool frequency criteria, a majority of patients had unclassified pattern, unlike by the stool form and patients' perception of their symptoms.


Abdominal pain Constipation Diarrhea Functional bowel disorders Functional gastrointestinal disorders 



The task force members thank Mr Dilip Kumar and Mr Ankit Shukla for helping in data management. The activities of the task force were supported by a full and unconditional grant from Dr Reddy's Laboratories, Hyderabad.

Supplementary material

12664_2013_365_MOESM1_ESM.doc (34 kb)
ESM 1 (DOC 34 kb)


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Copyright information

© Indian Society of Gastroenterology 2013

Authors and Affiliations

  • Uday C. Ghoshal
    • 1
  • Philip Abraham
    • 2
  • Shobna J. Bhatia
    • 3
  • Sri Prakash Misra
    • 4
  • Gourdas Choudhuri
    • 1
  • K. D. Biswas
    • 5
  • Karmabir Chakravartty
    • 6
  • Sunil Dadhich
    • 7
  • B. D. Goswami
    • 8
  • V. Jayanthi
    • 9
  • Sunil Kumar
    • 1
  • Abraham Koshy
    • 10
  • K. R. Vinay Kumar
    • 11
  • Govind Makharia
    • 12
  • Sandeep Nijhawan
    • 13
  • Nitesh Pratap
    • 14
  • Gautam Ray
    • 15
  • Sanjeev Sachdeva
    • 16
  • Shivaram Prasad Singh
    • 17
  • Varghese Thomas
    • 18
  • Harsh Udawat
    • 19
  1. 1.Department of GastroenterologySanjay Gandhi Postgraduate Institute of Medical SciencesLucknowIndia
  2. 2.Department of GastroenterologyP D Hinduja National Hospital and Medical Research CentreMumbaiIndia
  3. 3.Department of GastroenterologyK E M HospitalMumbaiIndia
  4. 4.Department of Gastroenterology, Moti Lal Nehru Medical CollegeUniversity of AllahabadAllahabadIndia
  5. 5.Department of GastroenterologyCalcutta Medical CollegeKolkataIndia
  6. 6.Department of GastroenterologyKothari Medical CentreKolkataIndia
  7. 7.Department of GastroenterologyS N Medical CollegeJodhpurIndia
  8. 8.Department of GastroenterologyGauhati Medical CollegeGuwahatiIndia
  9. 9.Department of GastroenterologyStanley Medical CollegeChennaiIndia
  10. 10.Department of HepatologyLakeshore HospitalKochiIndia
  11. 11.Medical College HospitalThiruvananthapuramIndia
  12. 12.Department of Gastroenterology and Human NutritionAll India Institute of Medical SciencesAnsari NagarIndia
  13. 13.Department of GastroenterologySawai Man Singh Medical CollegeJaipurIndia
  14. 14.Asian Institute of GastroenterologyHyderabadIndia
  15. 15.Department of GastroenterologyB R Singh HospitalKolkataIndia
  16. 16.Department of GastroenterologyG B Pant HospitalNew DelhiIndia
  17. 17.Department of GastroenterologyS C B Medical CollegeCuttackIndia
  18. 18.Department of GastroenterologyCalicut Medical CollegeCalicutIndia
  19. 19.Department of GastroenterologySantokba Durlabhji Memorial Hospital Cum Medical Research InstituteJaipurIndia

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