Irritable Bowel Syndrome (IBS) Manning Criteria

Manning criteria explained

The above calculator helps diagnose irritable bowel syndrome based on the Manning criteria which is a diagnosis algorithm. There are six criteria used in the evaluation of the patient:

■ Pain onset associated with frequent bowel movements;

■ Looser stools associated with onset of pain;

■ Pain relieved by defecation;

■ Noticeable abdominal bloating;

■ Sensation of incomplete evacuation more than 25% of the time;

■ Diarrhea with mucus more than 25% of the time.

Positive diagnosis is deemed when at least two of the above symptoms are present.

The Manning criteria was not found to provide sufficiently high sensitivity in the differential diagnosis of IBS with other gastrointestinal conditions such as non-ulcer dyspepsia or organic gastrointestinal disease.

Please note that although the criteria is deemed sufficient in correlating functional abdominal symptoms with IBS, further testing is required.

In the table below you can find the occurrence frequency of the Manning criteria, differentiated by gender:

The method is not the only diagnostic tool for irritable bowel syndrome. The Rome Criteria I and II or the Kruis criteria also help diagnose IBS.

A comparison study between the Manning and Rome criteria has shown that the former has more specificity but less sensitivity in diagnosis than the latter.

About the study

In 1978 Manning proposed a questionnaire that evaluated the presence of 15 irritable bowel syndrome symptoms. The questionnaire was administered to 109 patients who were referred to gastroenterology or surgery clinics with abdominal pain or a change in bowel habit or both.

These patients have been followed 17 to 26 months on, to check how many were diagnosed with IBS.

From 109 patients, 32 were diagnosed with IBS. The study found that four symptoms were more common among diagnosed patients:

■ Abdominal distension;

■ Relief of pain with bowel movement;

■ Looser bowel;

■ More frequent bowel movements with the onset of pain.

The study also found mucus and sensation of incomplete evacuation as common symptoms, relatable to IBS.

Other studies have found the diagnosis performance of the Manning criteria to be highly variable.

Irritable Bowel Syndrome (IBS) guidelines

IBS is characterized by altered bowel habits accompanied by abdominal distension and pain.

There are four types of this functional gastrointestinal disorder:

■ IBS-D: where diarrhea is predominant;

■ IBS-C: that is constipation predominant;

■ IBS-M: where diarrhea and constipation are mixed;

■ IBS-A: that alternates diarrhea and constipation.

Whilst changes of pattern, for example from IBS-C to IBS-D occur in 75% of patients, another common symptom is postprandial urgency.

Pain is strictly localized in the lower abdomen, in the left lower quadrant, and is only partially relieved by defecation.

Nausea or vomiting along with urinary frequency and sexual dysfunction are accompanying symptoms. In some cases, weight loss and gluten intolerance are also exhibited.

IBS diagnosis takes place through physical examinations, radiographic evidence and individual laboratory testing.

A complete blood count is performed to screen for anemia, along a metabolic panel and stool examination.

Original source

Manning AP, Thompson WG, Heaton KW, Morris AF. Towards positive diagnosis of the irritable bowel. Br Med J. 1978; 2(6138):653-4.

Validation

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; 161(17):2081-8.

Other references

1. Talley NJ, Phillips SF, Melton LJ, Mulvihill C, Wiltgen C, Zinsmeister AR. Diagnostic value of the Manning criteria in irritable bowel syndrome. Gut. 1990; 31(1):77-81.

2. 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; 145(6):1262-70.e1.