The Rome criteria represent a consensus viewpoint based on currently available data, but their development certainly does not establish that the content is truly indicative of a specific disease process. There is a limit to the repertoire of gastrointestinal symptoms; because of the low specificity of symptoms, it is understandable that symptoms alone are unlikely to be accurate enough. However, in the absence of a reproducible and accepted biological marker, symptoms currently remain the primary means of identifying and recruiting patients for research. All diagnostic criteria will continue to be controversial until the pathophysiology of irritable bowel syndrome (IBS) is better understood and treatment more appropriately targeted to relevant disturbances. The aim of this review is to present the current Rome criteria and critically evaluate the arguments for and against the individual components being included as part of the criteria.