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Pubmed-Modest conformity between self-reporting of Bristol stool form and fecal consistency measured by stool water content in irritable bowel syndrome, a FODMAP and gluten trial

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Am J Gastroenterol. 2022 Aug 12. doi: 10.14309/ajg.0000000000001942. Online ahead of print.


INTRODUCTION: Altered bowel habits constitute a criterion of irritable bowel syndrome (IBS), with the Bristol Stool Form Scale (BSFS) as recommended tool for assessment of fecal consistency. However, BSFS is devoid of a comprehensive objective evaluation in subjects with IBS. Therefore, we aimed to evaluate the concordance between subjective reporting of BSFS and objective stool water content in subjects with IBS. Furthermore, we evaluated if intake of FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) or gluten would affect stool water content.

METHOD: Data from a previous crossover trial in IBS with one-week provocations of FODMAPs, gluten or placebo were subanalysed. After each intervention, fecal consistency was subjectively assessed using the BSFS and stool samples were collected. Stool water content was analysed where ≤68.5% water content was classified as hard stool, while ≥78% was classified as diarrhea.

RESULTS: BSFS correlated to stool water content (r=0.36, p<0.0001) The BSFS score increased in parallel with increasing water content, but with considerable overlap between BSFS scores. Stool water content differed between the BSFS categories 1-2, 3-5 and 6-7 (hard, normal, loose) (p<0.0001). For BSFS categories 1-2, 77% had water content ≤68.5%, whereas for BSFS categories 6-7, 52% had water content ≥78%. There was no difference in stool water content after consumption of FODMAPs, gluten or placebo (p=0.94).

CONCLUSION: Subjective reporting of BSFS conforms only modestly with stool water content in IBS, warranting caution when subtyping IBS according to BSFS. High intake of FODMAP and gluten does not affect stool water content.

PMID:36087104 | DOI:10.14309/ajg.0000000000001942

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