J Neurogastroenterol Motil  
Prediction of Delayed Colonic Transit Using Bristol Stool Form and Stool Frequency in Eastern Constipated Patients: A Difference From the West
Veeravich Jaruvongvanich,1,2 Tanisa Patcharatrakul,2,3 and Sutep Gonlachanvit3*
1Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA; 2Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand; and 3Gastrointestinal Motility Research Unit, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Correspondence to: Sutep Gonlachanvit, MD, MSc
Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Pathumwan, Bangkok 10330, Thailand
Tel: +662-256-4265, E-mail: gsutep@hotmail.com
Received: February 19, 2017; Revised: March 17, 2017; Accepted: April 2, 2017; Published online: July 21, 2017.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

cc This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims The correlation between the Bristol stool form scale (BSFS) and colonic transit time (CTT) has been reported in Western populations. Our study aims to study the relationship between BSFS, stool frequency, and CTT in Eastern patients with chronic constipation.
Methods
A total of 144 chronic primary constipation patients underwent colonic transit study by using radio-opaque markers, anorectal manometry, and balloon expulsion test. Stool diary including stool forms and frequency was recorded. Delayed CTT was defined as the retention of more than 20.0% of radio-opaque markers in the colon on day 5.
Results
Twenty-five patients (17.4%) had delayed colonic transit. Average 5-day BSFS (OR, 0.51; 95% CI, 0.34-0.79; P = 0.021) and stool frequency (OR, 0.60; 95% CI, 0.44-0.83; P = 0.002) were independently associated with delayed CTT by logistic regression analysis. Average 5-day BSFS (area under the curve [AUC], 0.73; 95% CI, 0.62-0.84; P < 0.001) and stool frequency (AUC, 0.75; 95% CI, 0.63-0.87; P < 0.001) fairly predicted delayed CTT. The optimal average 5-day BSFS of ≤ 3 provided 68.0% sensitivity, 69.7% specificity, and 69.4% accuracy, and the optimal stool frequency ≤ 2 bowel movements in 5 days provided 64.0% sensitivity, 83.1% specificity, and 84.0% accuracy for predicting delayed CTT.
Conclusions
Both stool form and frequency were significantly associated with delayed CTT. Stool frequency ≤ 2 and BSFS 1-3 rather than BSFS 1-2 that was used in the Westerners could be used as surrogate for delayed CTT in Eastern patients with constipation.
Keywords: Bristol stool scale; Colonic motility; Colonic transit time; Constipation


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