Are the definitions for chronic diarrhoea adequate? Evaluation of two different definitions in patients with chronic
Per-Ove Stotzer1, Hasse Abrahamsson1, Antal Bajor1
1Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden.
Insights
The Bristol Stool Form Scale, assessing stool consistency, is a better indicator of organic causes of chronic diarrhoea than traditional frequency-based definitions. This helps in correctly identifying patients needing further investigation for gastrointestinal disorders.
Area of Science:
- Gastroenterology
- Diagnostic Accuracy
- Clinical Assessment
Background:
- The classical definition of chronic diarrhoea (≥3 stools/day, >200g, ≥4 weeks) may exclude patients with significant pathology.
- Alternative definitions focusing on stool form have been proposed to improve diagnostic accuracy.
Purpose of the Study:
- To compare the accuracy of the classic diarrhoea definition with one based on stool consistency using the Bristol Stool Form Scale.
- To determine the best diagnostic criteria for identifying organic causes of diarrhoea.
Main Methods:
- Patients underwent laboratory tests, upper/lower gastrointestinal endoscopy with biopsies, and SeHCAT scans.
- A one-week diary recorded stool frequency, consistency, and gastrointestinal symptoms (pain, bloating, gas).
Main Results:
- Eighty-six patients (62%) had abnormal stool consistency (mushy/loose), compared to 53 (38%) meeting the frequency criteria for diarrhoea.
- Organic diarrhoea causes were more accurately identified using stool consistency (80%) than frequency (47%).
- Stool form classification correctly identified more patients with organic or functional bowel disorders than the classic definition.
Conclusions:
- Loose stools, as defined by the Bristol Stool Form Scale, are a superior predictor of organic diarrhoea.
- Stool consistency assessment offers improved diagnostic utility for chronic diarrhoea compared to traditional frequency measures.
Background:
The classical definition of chronic diarrhoea is ≥3 defecations/day, with a stool weight of more than 200 g and duration of ≥4 weeks. However, with this definition many patients with substantial symptoms and pathology will be excluded from further investigations. As a consequence other definitions have been proposed, mainly based on evaluation of the stool form.
Objective:
To evaluate the accuracy of the classic criteria for diarrhoea in comparison with a definition based on stool consistency, using the Bristol Stool Form Scale.
Methods:
All patients were investigated with laboratory tests, upper and lower gastrointestinal endoscopy with biopsies, and SeHCAT test. They were asked to complete a diary recording stool frequency and consistency during a week, as well as other gastrointestinal symptoms (pain, bloating and gas).
Results:
One hundred and thirty-nine subjects were eligible for analysis. Ninety-one had an organic cause of diarrhoea. Fifty-three patients had ≥3 loose stools/day, whereas 86 reported <3 stools/day. Ninety had a median stool consistency that was mushy or loose and 49 had harder stools. A higher proportion of subjects with an organic cause of their diarrhoea compared with subjects with a functional bowel disorder had ≥3 loose stools/day, 43/91 (47%) vs. 10/48 (21%) (p < 0.01). Similarly, more subjects with an organic cause of their diarrhoea versus patients with a functional bowel disorder had a median stool consistency that was mushy or watery, 73/91 (80%) vs. 17/48 (35%), p < 0.0001. When diarrhoea was defined according to stool form, more patients were classified correctly as having a functional disorder or organic disorder, compared with the classical definition (p < 0.05).
Conclusion:
Loose stools defined according to the Bristol Stool Form scale seem to be the best predictor of having an organic cause of the diarrhoea.
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