Department of Biology and Biological Engineering, Food and Nutrition Science, Chalmers University of Technology, Gothenburg, Sweden.
Department of Medical Sciences, Gastroenterology/Hepatology, Uppsala University, Uppsala, Sweden .
Am J Gastroenterol. 2022 Oct 1;117(10):1668-1674. doi: 10.14309/ajg.0000000000001942. Epub 2022 Aug 12.
Altered bowel habits constitute a criterion of irritable bowel syndrome (IBS), with the Bristol Stool Form Scale (BSFS) as the 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 whether intake of fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) or gluten would affect stool water content.
Data from a previous crossover trial in IBS with 1-week provocations of FODMAPs, gluten, or placebo were subanalyzed. After each intervention, fecal consistency was subjectively assessed using the BSFS and stool samples were collected. The stool water content was analyzed, where ≤68.5% water content was classified as hard stool, while ≥78% was classified as diarrhea.
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, and loose, respectively) ( 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).
Subjective reporting of BSFS conforms only modestly with stool water content in IBS, warranting caution when subtyping IBS according to the BSFS. High intake of FODMAPs and gluten does not affect stool water content.
改变排便习惯构成肠易激综合征（IBS）的标准，布里斯托粪便形状量表（BSFS）被推荐作为粪便一致性评估的工具。然而，BSFS 缺乏对 IBS 患者的全面客观评估。因此，我们旨在评估 IBS 患者主观报告的 BSFS 与粪便水分含量之间的一致性。此外，我们还评估了摄入可发酵寡糖、双糖、单糖和多元醇（FODMAPs）或麸质是否会影响粪便水分含量。
对 IBS 的一项交叉试验的 1 周 FODMAPs、麸质或安慰剂激发后的前瞻性数据进行了亚分析。在每次干预后，使用 BSFS 主观评估粪便稠度，并收集粪便样本。分析粪便水分含量，将≤68.5%的水分含量归类为硬便，而≥78%的水分含量归类为腹泻。
BSFS 与粪便水分含量相关（ r = 0.36，P < 0.0001）。BSFS 评分随水分含量增加而增加，但 BSFS 评分之间有很大重叠。BSFS 类别 1-2、3-5 和 6-7 之间的粪便水分含量不同（分别为硬便、正常便和稀便）（ P < 0.0001）。对于 BSFS 类别 1-2，77%的粪便水分含量≤68.5%，而对于 BSFS 类别 6-7，52%的粪便水分含量≥78%。进食 FODMAPs、麸质或安慰剂后粪便水分含量无差异（ P = 0.94）。
BSFS 的主观报告与 IBS 患者的粪便水分含量仅略有一致性，因此根据 BSFS 对 IBS 进行亚型分类时需要谨慎。高 FODMAPs 和麸质摄入不会影响粪便水分含量。
