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Kruis Score for Diagnosis of Irritable Bowel Syndrome (IBS)

Calculators  Gastrointestinal
The presence of IBS (irritable-bowel-syndrome) is determined using clinically significant weighted criteria.
Symptoms of abdominal pain, flatulence, or bowel irregularity
No 0
Yes 34
Symptom duration > 2 years
No 0
Yes 16
Pain described as burning, cutting, very strong, terrible, feeling of pressure, dull, boring, or 'not so bad'
No 0
Yes 23
Alternating constipation and diarrhea
No 0
Yes 14
Abnormal physical findings or history pathognomonic of other disease
No 0
Yes -47
ESR > 10 mm/hr
No 0
Yes -13
WBC > 10,000/µL
No 0
Yes -50
Hemoglobin (female < 12 g/dL; male < 14 g/dL)
No 0
Yes -98
History of blood in stool
No 0
Yes -98


Measured Factor
Irritable bowel syndrome
Measured Factor Disease
  • Irritable bowel syndrome
Measured Factor Detail
The Kruis Score helps to differentiate IBS from organic bowel disease | It uses symptoms and lab testing to suggest which patients likely have IBS
Body System
Measured Factor Low Impact
  • If score is < 44, the test is negative for IBS
  • If any “red flags” are their, consider further assessment for other pathology.
Measured Factor High Impact
  • If score >44, positive for IBS.

Result Interpretation

Ranges Ranges
  • Critical Low: score >44
  • Critical High: < 44
Result Low Conditions
  • constipation
  • diarrhea
  • abdominal pain
  • flatulence
  • bowel irregularity
Test Limitations
Symptom-based criteria for diagnosis of IBS has unclear ovarall accuracy, need to improvement for specificity and sensitivity.
References: 2


Study Validation 1
Review of validation of diagnostic criteria based on symptoms for irritable bowel syndrome (IBS). There are two different kinds of validations reported: study testing patients with and without structural disease at colonoscopy discriminate by symptom criteria; study testing discrimination by symptom criteria to patients have IBS from positive diagnosis from healthy persons or patients having other structural and functional disorders. IBS is explained only with structural disease exclusion so the first study addresses that it can't provide positive predictive value or sensitivity. The second study validates the performance of the symptom criteria as predicted by its theory. Sensitivity, 0.4 to 0.9 by symptom-based criteria with clinical diagnosis. Patients with IBS who fulfill Rome II criteria have the poor quality of life as compared to patients who don't fulfill Rome II criteria. In addition, Rome I, Rome II, and Manning criteria have same specificity and sensitivity.
References: 3
Study Validation 2
Manning et al. explained that some symptoms distinguished between irritable bowel syndrome (IBS) and organic gastrointestinal disease (OGD). Which were abdominal distention, incomplete evacuation feeling, and pain with frequent stools. Kruis et al. explained other simple scoring system to distinguished IBS and OGD. A study was conducted to check the validity of Kruis scoring system and Manning's criteria when used combined and apart. The study based on 347 patients; 165 patients had IBS and 182 patients had OGD. 90% sensitivity and 87% specificity evaluated to distinguished both diseases with Manning's criteria, Kruis scoring system evaluated 81% sensitivity and 91% specificity by distinguishing IBS and OGD. Combined system evaluated 80% sensitivity and 97% specificity. In addition, both systems had strong co-relation by comparing IBS.
References: 4
Study Validation 3
An outpatient study was conducted to validate Kruis scoring system in the gastrointestinal clinic with various lab tests including upper and lower gastrointestinal tract endoscopy, and ultrasound. 209 patients underlying with symptoms organic disease and 108 patients with irritable bowel syndrome (IBS) without any organic disease. The study evaluated with 64% sensitivity and 99% specificity for the diagnosis of IBD and specificity was 97% at 83% sensitivity. In addition, scoring system well distinguished between organic diseases by physical exam, basic lab test, and detailed history.
References: 1
Study Additional 1
A systemic review was conducted from twenty two studies on 7106 patients for the accuracy of irritable bowel syndrome (IBS) diagnostic criteria. Confidence intervals (CIs) of Roma III criteria were 95%, 3.35 (2.97 to 3.79) and 95%, 0.39 (0.34 to 0.46). 95% CIs 26.4 (11.4 to 61.9) of intestinal permeability, faecal calprotectin and Roma I criteria. In addition, symptom-based criteria, psychological markers and biomarkers performed in predicting IBS.
References: 5
Study Additional 2
A study was conducted to check the effect of probiotic Escherichia coli Nissle 1917 (EcN) for irritable bowel syndrome (IBS). Total 120 patients were included for the double-blind study based on the Roma III criteria. 60 patients were administered with placebo and 60 with EcN for 12 weeks. After 10 and 11 weeks, there were significant differences that EcN group had 20% points with 95% CI 2.6; 37.4, p = 0.01 and placebo group had 18.3 points with 95% CI 1.0; 35.7, p = 0.02. In addition, probiotic showed effects in irritable bowel syndrome.
References: 6


  1. Kruis W, Thieme C, Weinzierl M, Schüssler P, Holl J, Paulus W. A diagnostic score for the irritable bowel syndrome. Its value in the exclusion of organic disease. Gastroenterology. 1984;87(1):1-7.
  2. Moayyedi P, Ford AC. Symptom-based diagnostic criteria for irritable bowel syndrome: the more things change, the more they stay the same. Gastroenterol Clin North Am. 2011;40(1):87-103.
  3. Whitehead WE, Drossman DA. Validation of symptom-based diagnostic criteria for irritable bowel syndrome: a critical review. Am J Gastroenterol. 2010;105(4):814-20.
  4. Doğan UB, Unal S. Kruis scoring system and Manning's criteria in diagnosis of irritable bowel syndrome: is it better to use combined?. Acta Gastroenterol Belg. 1996;59(4):225-8.
  5. Sood R, Gracie DJ, Law GR, Ford AC. Systematic review with meta-analysis: the accuracy of diagnosing irritable bowel syndrome with symptoms, biomarkers and/or psychological markers. Aliment Pharmacol Ther. 2015;42(5):491-503.
  6. Kruis W, Chrubasik S, Boehm S, Stange C, Schulze J. A double-blind placebo-controlled trial to study therapeutic effects of probiotic Escherichia coli Nissle 1917 in subgroups of patients with irritable bowel syndrome. Int J Colorectal Dis. 2012;27(4):467-74.

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