Rome III Versus Rome IV Criteria for Diagnosing Irritable Bowel Syndrome in a Southeast Asian Population: Insights From the Rome Foundation Global Epidemiology Study Household Survey

Introduction: Previous Asian studies have reported a substantial decline in irritable bowel syndrome (IBS) prevalence following the adoption of the Rome IV diagnostic criteria. However, comparative data on IBS prevalence using Rome III and Rome IV criteria remain sparse, especially in Southeast Asia. Methods: We analyzed household survey data from the Rome Foundation Global Epidemiology Study conducted in Malaysia and Indonesia, the only Southeast Asian countries included in the study, utilizing household-based sampling. We compared diagnostic sensitivity between Rome III and Rome IV criteria for IBS and examined demographic characteristics, symptom severity, psychological distress, quality of life (QoL), healthcare utilization, and dietary habits among identified IBS participants. Result: Of 3411 participants (Malaysia: 2072; Indonesia: 1339), 177 (5.2%) fulfilled IBS criteria according to either Rome III or IV criteria. Among these, 115 (65%) met only the Rome III criteria, 50 (28%) met both the Rome III and IV criteria, and 12 (7%) exclusively met the Rome IV criteria. Compared with those diagnosed by Rome III, individuals identified by Rome IV criteria were younger and predominantly female. Only 31% of the Rome III IBS cases remained classified as IBS under the Rome IV criteria, while others were reclassified as unspecified bowel disorder (24%) or functional constipation (17%). While healthcare utilization rates were similar across groups, Rome IV IBS participants exhibited significantly higher symptom severity, lower anxiety levels, and poorer mental health-related QoL. Dietary assessments revealed significantly lower intake of milk, meat products, fish, eggs, vegetables and legumes, fruit, bread, and pasta among Rome IV IBS participants. Conclusion: The Rome IV criteria for IBS demonstrate reduced diagnostic sensitivity compared with the Rome III criteria in the Southeast Asian populations. Individuals meeting the Rome IV criteria displayed distinct demographic and clinical characteristics, including greater symptom severity and reduced mental health-related QoL.