Department of Gastroenterology, Eastern Health Clinical School, Monash University, Box Hill, Vic., Australia.
Department of Gastroenterology, Central Clinical School, Monash University, Melbourne, Vic., Australia.
Neurogastroenterol Motil. 2018 Feb;30(2). doi: 10.1111/nmo.13187. Epub 2017 Aug 10.
Perception of diarrhea and constipation differs greatly. This study aimed to correlate subjective and objective assessment of fecal characteristics in irritable bowel syndrome (IBS) patients.
Data from two interventional dietary trials with varying FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols) or gluten content were interrogated. Subjects rated their dissatisfaction with stool consistency daily using a visual analog scale during the interventions. Subjects collected stools at the end of each intervention. Each stool was scored according to the King's Stool Chart (KSC). Fecal water content (FWC) was measured on pooled feces by freeze drying, with diarrhea defined as ≥78%.
Seventy IBS (Rome III) and eight healthy subjects were studied. Each subject's self-rating of stool consistency during the most symptomatic diet was approximately double that of their least. Degree of dissatisfaction with stool consistency correlated poorly with changes in FWC and KSC. IBS subtype related poorly to objective measures of stool consistency. Sixty percent of IBS-D subjects had diarrhea on objective measures. Eighty-five percent with IBS-C had hard and formed stools but three patients met the criteria for diarrhea. One healthy subject had diarrhea on FWC and KSC, and six had hard, formed stools. No differences in FWC was observed when subjects consumed differing amounts of FODMAPs or gluten (all P > .200).
There are major disparities between patients' stool descriptions and objective features of constipation and diarrhea. Patient-reported bowel habits require more interrogation for accurate IBS subtyping. Varying FODMAP or gluten content of the diet is not associated with consistent change in FWC.
人们对腹泻和便秘的感知差异很大。本研究旨在对肠易激综合征（IBS）患者粪便特征的主观和客观评估进行相关性分析。
对两项不同 FODMAP（可发酵寡糖、双糖、单糖和多元醇）或麸质含量的干预性饮食试验的数据进行了分析。在干预期间，受试者每天使用视觉模拟量表对粪便稠度的不满程度进行评分。在每个干预结束时，受试者收集粪便。根据 King's 粪便图表（KSC）对每个粪便进行评分。通过冷冻干燥测量混合粪便中的粪便含水量（FWC），粪便含水量≥78%定义为腹泻。
研究了 70 名 IBS（罗马 III 型）和 8 名健康受试者。每个受试者在最敏感饮食期间自评的粪便稠度大约是最不敏感饮食时的两倍。对粪便稠度的不满程度与 FWC 和 KSC 的变化相关性较差。IBS 亚型与粪便稠度的客观测量相关性较差。60%的 IBS-D 患者在客观测量时出现腹泻。85%的 IBS-C 患者有硬而成形的粪便，但有 3 名患者符合腹泻标准。1 名健康受试者在 FWC 和 KSC 上出现腹泻，6 名健康受试者出现硬而成形的粪便。当受试者摄入不同量的 FODMAP 或麸质时，FWC 没有差异（所有 P>.200）。
患者对粪便的描述与便秘和腹泻的客观特征存在较大差异。需要对患者报告的肠道习惯进行更深入的询问，以进行准确的 IBS 亚型分类。饮食中 FODMAP 或麸质含量的变化与 FWC 的一致变化无关。
