More than just IBS: the expanded world of bowel DGBIs

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More than just IBS: the expanded world of bowel DGBIs

Author: Dr. Bahir Hadi, Consultant Surgeon, PhD · Date: June 2026

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Abstract

When people think of chronic gut issues, irritable bowel syndrome (IBS) is usually the first name mentioned. But under the updated Rome V criteria, IBS is just one member of a larger family known as Bowel Disorders / bowel DGBIs - conditions in which intestinal motility, sensitivity and communication with the central nervous system are disturbed [1, 2].

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The big update: the return of "discomfort"

One of the most significant shifts in Rome V was the formal reintroduction of the word "discomfort" alongside "pain" for diagnosing IBS [1]. If you experience chronic bloating, pressure or a vague sense of gut unease paired with altered bowel habits, you no longer fly under the diagnostic radar [1].

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The six subtypes of bowel DGBIs

Rome V splits bowel disorders into six distinct clinical buckets [1, 2]:

1. Irritable bowel syndrome (IBS) - chronic abdominal pain or discomfort linked to changes in stool form or frequency. Divided into IBS-C (constipation), IBS-D (diarrhoea), IBS-M (mixed) and IBS-U (unclassified).
2. Chronic constipation - persistent hard, infrequent or difficult-to-pass stools without dominant abdominal pain.
3. Functional diarrhoea - recurring loose stools without identifiable organic disease or pain.
4. Functional bloating and distension - chronic feelings of internal fullness or measurable abdominal swelling that overshadow other symptoms.
5. Unclassified bowel disorder - for patients who clearly have a gut-brain bowel malfunction but don't neatly fit the criteria above.
6. Opioid-induced constipation (OIC) - caused by a drug, but classified here because it mimics functional constipation mechanisms.

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A shift toward "positive diagnosis"

The era of treating bowel DGBIs as a "diagnosis of exclusion" - running dozens of invasive tests before naming the condition - is officially over [1]. Rome V encourages clinicians to make a confident, positive diagnosis based on symptom patterns and only extend work-up (e.g. colonoscopy, faecal calprotectin) when clear alarm features are present: rectal bleeding, weight loss, anaemia, onset over 50, or family history of bowel cancer [1].

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Treatment

Treatment is multimodal and tailored to subtype: low-FODMAP diet, antispasmodics, neuromodulators, probiotics and psychological interventions (CBT, gut-directed hypnotherapy) [1, 2].

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Work-up at Kirurgen.dk

We offer colonoscopy, sigmoidoscopy, coeliac screening, faecal calprotectin and structured IBS work-up. Continue the series: Oesophageal DGBIs, Gastroduodenal DGBIs, Centrally mediated pain, Anorectal DGBIs.

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References

1. Rome Foundation. Rome V Diagnostic Criteria for Disorders of Gut-Brain Interaction. Drossman DA, Tack J, Chang L et al. (eds.), 2026 update.
2. Mearin F, Lacy BE, Chang L et al. Bowel Disorders. Rome IV/V chapter on IBS subtypes, functional constipation, functional diarrhoea and functional bloating. Gastroenterology - consensus article.