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Manning Criteria for Diagnosis of Irritable Bowel Syndrome (IBS)

Manning Criteria is effecient diagnostic tool which determine the chances of occurinjg Irritable bowel syndrome in patients
Onset of pain related to frequent bowel movements
No 0
Yes 10
Looser stools associated with onset of pain
No 0
Yes 10
Pain relieved by passage of stool
No 0
Yes 10
Abdominal bloating
No 0
Yes 10
Sensation of incomplete evacuation > 25% of the time
No 0
Yes 10
Diarrhea with mucus > 25% of the time
No 0
Yes 10
Age > 50 years
No 0
Yes 1
Loss in weight
No 0
Yes 1
Blood in stools
No 0
Yes 1
No 0
Yes 1
No 0
Yes 1


Measured Factor
Manning criteria
Measured Factor Disease
  • Inflammatory bowel syndrome
Measured Factor Detail
Manning criteria quantifies the prediction of occuring IBS in a suspected individual. The manning criteria is fulfilled only if more than 3 green flags are marked positive with no red flag marked. Even if one red flag is marked then manning criteria cannot give conclusive evidence of IBS occurence.
Body System
Measured Factor Low Impact
  • If less than 3 green flags are marked or one of the red flag is marked IBS likelihood is not present.
Measured Factor High Impact
  • If more than 3 green flags with no red flags are marked IBS may persist in an individual.

Result Interpretation

Ranges Ranges
  • Critical High: All 5 green flags are marked with no red flag in positive.
  • Normal: <3 green flag marked | 1 red flag marked
  • Normal Adult Male: <3 green flag marked | 1 red flag marked
  • Normal Adult Female: <3 green flag marked | 1 red flag marked
  • Normal Pediatric: <3 green flag marked | 1 red flag marked
  • Normal Neonate Female: <3 green flag marked | 1 red flag marked
  • Normal Geriatric Male: <3 green flag marked | 1 red flag marked
  • Normal Geriatric Female: <3 green flag marked | 1 red flag marked
Result High Conditions
  • Inflammed bowel syndrome
Test Limitations
Manning criteria have a low threshold for severity and no duration criteria
References: 2


Study Validation 1
This systematic review was aimed to evaluate the existing diagnostic criteria for patients with suspected inflammatory bowel disease (IBS). For this 13 published studies related to the effectiveness, accuracy and validation of current diagnostic approaches for IBS was reviewed. Expert panel of specialist and physicians were involved to assess the literature. Delphi technique was utilized for developing a consensus of diagnostic criteria. After the analysis by consensus from experts and literature review a diagnostic algorithm was developed that focused a symptom-based diagnostic strategy. This algorithm comprised of 3 sub categories based on predominant symptom pattern (constipation, diarrhea, and pain) and severity level, and a subspecialist referral module. This review concludes that there is still need for more validation studies to identify strong diagnostic criteria for early detection of Irritable bowel syndrome
References: 3
Study Validation 2
The aim of this retrospective blinded study was to validate the Rome and Manning criteria to identify patients with for irritable bowel syndrome (IBS). A total 1848 patients who underwent colonoscopy were involved in the study and their complete symptom, colonoscopy, and histology data was collected. The primary outcome measured was pain or discomfort in association with a change in bowel habit and no organic gastrointestinal disease. Both Rome and Manning criteria were used to evaluate IBS. Results showed that sensitivity of Manning and Rome criteria was 69.9% and 95.8% respectively. Specificity varied from 70.6% (Rome I) to 81.8% (Manning). This study concluded that both criteria perform in modest way to identify IBS in suspected subjects and there is still need of better approaches for IBS diagnosis
References: 4
Study Validation 3
The purpose of this study was to compare the performance of different diagnostic criteria for IBS in patients of India. Study involved 1618 patients from 17 centers who presented with lower gastrointestinal (GI) symptoms. Manning’s and Rome I, II, III criteria was employed in all the patients. Frequent stools with onset of pain, loose stool with onset of pain, relief of pain with passage of stool were primary evaluation parameters evaluated in patients. Based on these parameters subtypes of IBS was assigned to patients which were diarrhea-predominant IBS, constipation-predominant IBS and unclassified IBS. This study concluded that Manning's criteria was more appropriate approach than Rome criteria to diagnose the IBS in patients.
References: 5
Study Additional 1
This study was aimed to determine the sensitivity of the Rome III criteria in relation to clinical diagnosis evaluated by General practitioner. A total 499 patients were involved in the study with mean age of 32.8 years. The Manning and Rome I-III criteria were assessed through interview and patient also completed questionnaires Gastrointestinal Symptom Rating Scale (GSRS). Results showed that Rome III-positive patients reported upset defecation, a higher symptom burden and lower quality of life when compared with Rome III-negative patients. This study concluded that Rome III criteria was able to scrutinize three out four patients with IBS and can be clinically effective criteria.
References: 6
Study Additional 2
This systematic review was conducted to evaluate the validation and use IBS criteria in suspected patients. Review was conducted in two stages. First stage was about searching the review of literature from 1978 validating the IBS diagnostic criteria. 14 published studies were found validating diagnostic tests for IBS. Second stage involved selection of studies published in IBS between 1992 and 2011. Based on the information collected during both phases this review concluded that Manning criteria was most valid and reliable criteria and Rome III was not a validated tool and doesn’t find much clinical relevance.
References: 7
Study Additional 3
The aim of this population-based postal study was to evaluate the performance of four IBS diagnostic criteria. Questionnaire was sent to the patients of same age and gender who were randomly categorized. IBS criteria were evaluated using Manning criteria, Rome II, Rome III, subgroups and self-report. Results for prevalence of IBS were shown as Manning showed the highest (32%) and Rome II the lowest (5%). This study concluded that the Manning and self-report criteria had high sensitivity and low specificity, while Rome III criteria had low sensitivity and high specificity in diagnosing IBS.
References: 8


  1. Manning AP, Thompson WG, Heaton KW, Morris AF. Towards positive diagnosis of the irritable bowel. Br Med J. 1978 Sep 2;2(6138):653-4.
  2. Boyce PM, Koloski NA, Talley NJ. Irritable bowel syndrome according to varying diagnostic criteria: are the new Rome II criteria unnecessarily restrictive for research and practice?. Am J Gastroenterol. 2000;95(11):3176-83.
  3. Fass R, Longstreth GF, Pimentel M, Fullerton S, Russak SM, Chiou CF, Reyes E, Crane P, Eisen G, McCarberg B, Ofman J. Evidence- and consensus-based practice guidelines for the diagnosis of irritable bowel syndrome. Arch Intern Med. 2001 Sep 24;161(17):2081-8.
  4. Ford AC, Bercik P, Morgan DG, Bolino C, Pintos-Sanchez MI, Moayyedi P. Validation of the Rome III criteria for the diagnosis of irritable bowel syndrome in secondary care. Gastroenterology. 2013 Dec;145(6):1262-70.e1. doi: 10.1053/j.gastro.2013.08.048.
  5. Ghoshal UC, Abraham P, Bhatia SJ, Misra SP, Choudhuri G, Biswas KD, et al. Comparison of Manning, Rome I, II, and III, and Asian diagnostic criteria: report of the Multicentric Indian Irritable Bowel Syndrome (MIIBS) study. Indian J Gastroenterol. 2013 Nov;32(6):369-75. doi: 10.1007/s12664-013-0365-7.
  6. Engsbro AL, Begtrup LM, Kjeldsen J, Larsen PV, de Muckadell OS, Jarbøl DE, Bytzer P. Patients suspected of irritable bowel syndrome--cross-sectional study exploring the sensitivity of Rome III criteria in primary care. Am J Gastroenterol. 2013 Jun;108(6):972-80. doi: 10.1038/ajg.2013.15.
  7. Dang J, Ardila-Hani A, Amichai MM, Chua K, Pimentel M.Systematic review of diagnostic criteria for IBS demonstrates poor validity and utilization of Rome III. Neurogastroenterol Motil. 2012 Sep;24(9):853-e397. doi: 10.1111/j.1365-2982.2012.01943.x
  8. Olafsdottir LB, Gudjonsson H, Jonsdottir HH, Thjodleifsson B. Stability of the irritable bowel syndrome and subgroups as measured by three diagnostic criteria -a 10-year follow-up study. Aliment Pharmacol Ther. 2010 Sep;32(5):670-80. doi: 10.1111/j.1365-2036.2010.04388.x.

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