Escalas validadas para avaliação das fezes: revisão integrativa / Validated scales for stool assessment: integrative review

Introdução: A eliminação intestinal é uma necessidade fisiológica humana básica, que deve ser considerada e avaliada em toda a assistência prestada pelos profissionais de saúde. Objetivo: identificar as escalas validadas utilizadas na atualidade para avaliação das fezes em adultos e idosos. Método: revisão integrativa, protocolada na plataforma Open Science Framework, cujo registro está disponível sob o DOI https://doi.org/10.17605/OSF.IO/9CTMB, que incluiu estudos primários publicados na íntegra, que utilizaram escalas para avaliação de fezes, publicados nos idiomas inglês, português ou espanhol, no período de janeiro de 2001 a julho de 2021. As buscas foram realizadas nas bases de dados eletrônicas PubMed, LILACS, CINAHL e EMBASE em 16 de julho de 2021. Em seguida, as referências identificadas foram exportadas para o aplicativo Rayyan para remoção das duplicatas, seleção e avaliação dos estudos por dois revisores de forma independente e mascarada; os casos de divergência foram avaliados por um terceiro revisor. As evidências foram sintetizadas de forma descritiva. Resultados: a busca nas bases de dados resultou em 1.567 estudos. Após o processo de seleção e leitura na íntegra, 353 estudos foram considerados nesta revisão, dos quais 339 utilizaram escalas validadas (333 estudos utilizaram a Escala de Bristol e seis outras escalas) e 14 escalas não validadas. Também se verificou aumento na quantidade de publicações que avaliaram a consistência das fezes a partir do ano de 2015. Após a leitura dos 353 estudos, foram identificadas cinco escalas validadas: Escala de Forma das Fezes de Bristol, King's Stool Chart, Escala de consistência das fezes segundo Anastasi e Capili (2001) e Hansen (1981), Escala pictórica validada do Diarrhea Questionnaire e a ferramenta de avaliação fecal de Ohno. Conclusão: foram identificadas cinco escalas validadas e utilizadas nos últimos 20 anos para avaliação das fezes. Adicionalmente, os dados mostraram aumento mundial do uso das escalas e a necessidade de desenvolvimento de uma escala para avaliação das fezes com estudos de validação mais robustos

Introduction: Bowel elimination is a basic human physiological need, which must be considered and evaluated in all care provided by health professionals. Aim: to identify the validated scales used to assess stool in adults and the elderly. Method: an integrative review, registered on the Open Science Framework platform and available under DOI 10.17605/OSF.IO/9CTMB, which included primary studies published in full that used scales for stool assessment, published in English, Portuguese or Spanish, between January 2001 and July 2021. Searches of the PubMed, LILACS, CINAHL, and EMBASE electronic databases were performed on July 16, 2021. Afterward, the identified references were exported to the Rayyan application for removal of duplicates, selection, and independent and masked evaluation of studies by two reviewers; cases of divergence were evaluated by a third reviewer. The evidence was synthesized descriptively. Results: the database search resulted in 1,567 studies. After the selection process and reading in full, 353 studies were considered in this review. Of these 353, 339 used validated scales (333 studies used the Bristol Scale and six studies used other scales) and 14 studies used non-validated scales. There was also an increase in the number of publications that evaluated stool consistency from the year 2015. After reading the 353 studies, five validated scales were identified: Bristol Stool Form Scale, King's Stool Chart, Stool Consistency Scale according to Anastasi and Capili (2001) and Hansen (1981), the Diarrhea Questionnaire's validated pictorial scale, and Ohno's fecal assessment tool. Conclusion: Five validated scales were identified and used in the last 20 years for stool assessment. Additionally, the data showed a worldwide increase in the use of scales and the need to develop a scale to assess stool with more robust validation studies

Usefulness of Assessment of Stool Form by the Modified Bristol Stool Form Scale in Primary Care Pediatrics / 대한소아소화기영양학회지

PURPOSE: Rome criteria are considered the gold standard for diagnosing functional constipation. The modified Bristol stool form scale (m-BSFS) was validated to measure stool form in children. However, neither the potential use of the m-BSFS as a tool to facilitate the diagnosis of potential constipation, nor the agreement between m-BSFS and stool consistency by Rome has been studied. Our objective is to determine if m-BSFS is a reliable tool to facilitat detection of constipation; and the agreement between stool form by m-BSFS and hard stool criteria in Rome. METHODS: A survey tool with the Rome III criteria and the m-BSFS was developed. A Likert-scale addressed frequency of each stool form on the m-BSFS. Responses to Rome III and m-BSFS were compared. RESULTS: The sensitivity and specificity of the m-BSFS was 79.2% and 66.0% respectively; and in children <4 years. improved to 81.2% and 75.0% respectively. There was poor agreement between hard stools by m-BSFS and the painful or hard bowel movement question of Rome Criteria. CONCLUSION: The potential utility of m-BSFS as a reasonably good tool to facilitate the diagnosis of potential constipation in children is shown. The poor agreement between painful or hard stool question in Rome III, and ratings for hard stool on the m-BSFS illustrates that one's perception may differ between a question and a picture. A useful pictorial tool to appraise stool form may, thus, be a favorable complement in the process of enquiry about bowel habits in well-child care.

Clinical Observation of Ordinary Acupuncture plus Zhigou (TE6) and Zhaohai (KI6) for Constipation Due to Yin Deficiency in Parkinson's Disease / 上海针灸杂志

Objective To observe the clinical efficacy of ordinary acupuncture plus Zhigou (TE6) and Zhaohai (KI6) in treating constipation due to yin deficiency in Parkinson's disease. Method Sixty eligible patients were randomized into a control group and a treatment group, 30 cases each. The control group was intervened by ordinary acupuncture by selecting the Dance-tremor Control Zone, Baihui (GV20), Fengchi (GB20), Fengfu (GV16), Quchi (LI11), Yanglingquan (GB34), Taixi (KI3) and Taichong (LR3). Based on the ordinary acupuncture, Zhigou (TE6) and Zhaohai (KI6) were added in the treatment group. The treatment was given three times a week, 12 sessions as a course, and the therapeutic efficacy was evaluated after 2 successive treatment courses by using Patient Assessment of Constipation Quality of Life Scale (PAC-QOL), Bristol Stool Scale (BSS), Cleveland Clinic Score (CCS) and Unified Parkinson's Disease Rating Scale (UPDRS) as the observation indexes. Result Before the intervention, there were no significant differences in comparing the PAC-QOL, Bristol, CCS and UPDRS scores between the two groups (P>0.05);after the treatment, the scores of PAC-QOL, Bristol, CCS, and motor function and activities of daily living in UPDRS dropped significantly in the two groups (P<0.05); the PAC-QOL, Bristol and CCS scores in the treatment group were significantly lower than those in the control group after the treatment (P<0.05); the treatment group had a significantly higher effective rate in improving constipation symptoms than the control group (P<0.05); there was no significant difference in comparing the UPDRS score between the two groups after the intervention (P>0.05). Conclusion Ordinary acupuncture plus Zhigou and Zhaohai can significantly improve the quality of life, stool form and difficulty in defecation in constipation of yin-deficiency type in Parkinson's disease, and the therapeutic efficacy is superior to that of ordinary acupuncture.

Prediction of Delayed Colonic Transit Using Bristol Stool Form and Stool Frequency in Eastern Constipated Patients: A Difference From the West

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 functional 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. Mean 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. Mean 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 mean 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.

Escala Bristol de forma fecal no diagnóstico clínico da constipação na infância, Porto Alegre, Brasil / The Bristol Stool Scale in the clinical diagnosis of childhood constipation

Introdução: A constipação é frequente na infância, podendo evoluir até a adolescência e vida adulta.O diagnóstico é clínico, realizado através da descrição subjetiva das fezes. A Escala Bristol facilita o diagnóstico, analisando a consistência das fezes. O objetivo deste estudo é descrever a utilização dessa escala no diagnóstico da constipação na infância. Métodos: Foi realizado um estudo transversal, no Ambulatório do HMIPV/Porto Alegre/RS, de abril a outubro de 2015, com pacientes consecutivos, de idade entre 05 e 12 anos. Todos foram submetidos à anamnese, para descrição subjetiva das fezes pelo responsável e pelo paciente. A médica pontuava a Escala Bristol baseada nesta descrição, seguida pela pontuação do paciente e do responsável. Resultados: Foram estudados 30 pacientes, com média de idade de 8,1± 2,5 anos. A pontuação da médica na Escala Bristol foi 1,83±0,38, a da mãe, 2,43±0,97 (P=0,001) e a do paciente, 2,27±0,87 (P=0,003). O coeficiente kappa entre o Bristol medido pela médica e pela mãe do paciente foi baixo, igual a 0,30 (P< <0,001) , bem como o coeficiente kappa entre o Bristol medido pela médica e pela criança, igual a 0,34(P< 0001). Conclusão: Houve diferença entre o Bristol pontuado pela médica e o Bristol pontuado pelas mães e pacientes. Os pacientes e as mães, ao pontuar na Escala Bristol, concordam pouco com a pontuação da médica. Os autores sugerem a multiplicação desta experiência em outros locais para continuar avaliando a utilização da Escala Bristol para Consistência Fecal na constipação da infância(AU)

Introduction: Constipation is common in childhood and can progress through adolescence and adulthood. Clinical diagnosis is performed by subjective description of the stools. The Bristol Scale facilitates the diagnosis by analyzing stool consistency. The aim of this study is to describe the use of this scale in the diagnosis of childhood constipation. Methods: A cross-sectional study was conducted at the Clinic of HMIPV/Porto Alegre from Apr to Oct 2015, with consecutive patients aged between 5 and 12 years. All were submitted to anamnesis for a subjective description of the stools by parent and patient. First the physician scored this description using the Bristol scale, followed by the patient's and parent's scores. Results: Thirty patients were studied with a mean age of 8.1 ± 2.5 years. The Bristol scale score by physician was 1.83 ± 0.38, by parent 2.43 ± 0.97 (P = 0.001), and by patient 2.27 ± 0.87 (P = 0.003). The kappa coefficient between physician and parent scores was low, 0.30 (P< 0.001), as well as between physician and child scores, 0.34 (P< 0001). Conclusion: There was a difference between the Bristol Scale scores by the physician and by the parents/patients. The Bristol scale scores by the patients/parents showed little agreement with those by the physician. The authors suggest the replication of this experience elsewhere to continue evaluating the use of the Bristol Stool Scale in childhood constipation(AU)

Electroacupuncture in Treating Severe Functional Constipation：A Randomized Controlled Trial / 上海针灸杂志

Objective To observe the clinical efficacy of electroacupuncture in treating severe functional constipation. Method Seventy patients with severe functional constipation were randomized into a treatment group (35 cases) and a control group (35 cases). The treatment group was intervened by deeply needling bilateral Tianshu (ST25) and Fujie (SP14) with electrical stimulation in addition to ordinary acupuncture at bilateral Shangjuxu (ST37);the control group was by superficially needling the areas beside bilateral Tianshu, Fujie and Shangjuxu with sham electroacupuncture. The two groups were both treated for successive 8 weeks and were followed up for another 3 months. The complete spontaneous bowel movements (CSBMs), Bristol stool form Scale (BSFS) and difficulty in bowel movements were observed every week. Result The two groups both showed significant improvements in average weekly CSBMs (P0.05). Conclusion Electroacupuncture can improve CSBMs in severe functional constipation, but it’s insignificantly different from sham acupuncture in improving stool form and defecation difficulty.

Therapeutic Observation of Electroacupuncture and Prucalopride Succinate Tablets for Functional Constipation / 上海针灸杂志

ObjectiveTo observe the clinical efficacies of electroacupuncture and Prucalopride succinate tablets in treating functional constipation.MethodForty patients were randomized into two groups, 20 cases in each group. The treatment group was intervened by electroacupuncture, and the control group was byoral administration of Prucalopride succinate tablets. The major symptoms scores, stool shape score, serum substance P (SP), and somotostatin (SS) were observed.ResultAfter treatment, there were no significant inter-group differences in comparing the changes of defecation frequency and difficulty scores (P>0.05), while there were significant inter-group differences in comparing the changes of incomplete bowel evacuation sensation, abdominal pain, and stool shape scores (P0.05).ConclusionElectroacupuncture and Prucalopride succinate tablets can produce equivalent efficacies in treating functional constipation, and have their own advantages in improving the relevant symptoms. Therefore, treatment should be chosen according to the disease condition.

Pharmacological intervention of HIV-1 maturation

Despite significant advances in antiretroviral therapy, increasing drug resistance and toxicities observed among many of the current approved human immunodeficiency virus (HIV) drugs indicate a need for discovery and development of potent and safe antivirals with a novel mechanism of action. Maturation inhibitors (MIs) represent one such new class of HIV therapies. MIs inhibit a late step in the HIV-1 Gag processing cascade, causing defective core condensation and the release of non-infectious virus particles from infected cells, thus blocking the spread of the infection to new cells. Clinical proof-of-concept for the MIs was established with betulinic acid derived bevirimat, the prototype HIV-1 MI. Despite the discontinuation of its further clinical development in 2010 due to a lack of uniform patient response caused by naturally occurring drug resistance Gag polymorphisms, several second-generation MIs with improved activity against viruses exhibiting Gag polymorphism mediated resistance have been recently discovered and are under clinical evaluation in HIV/AID patients. In this review, current understanding of HIV-1 MIs is described and recent progress made toward elucidating the mechanism of action, target identification and development of second-generation MIs is reviewed.

Metabolomic Study of a Diagnostic Model for the Metabolites of Stool Fat / 대한소화기학회지

BACKGROUND/AIMS: Metabolomics is a powerful tool for measuring low-molecular-weight metabolites in an organism at a specified time under specific environmental conditions. The aim of this study was to determine the usefulness of metabolomics in identifying the metabolites in stool-fat-positive specimens, and to establish whether the results could be used to predict the long-term prognosis. METHODS: Fecal specimens were collected from 52 subjects with bowel habit change. The subjects were accessed using Rome III questionnaires and Bristol stool scale form, and followed after three years. The feces samples were centrifuged and the resulting extracts reconstituted for liquid chromatography/mass spectrometry analysis. The datasets were autoscaled, log-transformed, and mean-centered in a column-wise fashion prior to principal-components analysis and partial least-squares-discrimination analysis modeling. RESULTS: Fecal samples from 10 of the 52 patients gave a positive stool-fat result of 30-100 microm; those of the remaining 42 contained neither fatty acids nor neutral fats. The peak intensities of lithocholic acid (p=0.001), lysophosphatidyl ethanolamine (lysoPE) 16:0 (p=0.015), and lysoPE 18:1/0:0 (p=0.014) were correlated with the size of the fatty acid. Subjects with positive stool-fat result showed higher score in Bristol stool scale form than those with negative stool-fat result at initial (p=0.040) and after three years (p=0.012). CONCLUSIONS: The metabolomic assay of stool fatty acid revealed mainly lysoPEs and lithocholic acid. The size of the fatty acid was correlated with higher concentrations of lysoPEs and lithocholic acid in stool-fat-test-positive specimens and related to loose stool even after three years of follow-up period.

Evaluación del hábito intestinal en una población de personal hospitalario / Evaluation of bowel habits in a population of hospital staff

Introducción: La función evacuatoria y sus alteraciones constituyen un motivo de consulta muy frecuente. En Venezuela no disponemos de información para definir cuál es el patrón intestinal normal de nuestra población, ni de la frecuencia con que se presentan dichas alteraciones.Objetivo: Evaluar el hábito intestinal en una población de personal hospitalario, entre 18 a 70 años, del Hospital “Dr. Domingo Luciani” entre abril - septiembre del 2008.Método: Es un estudio descriptivo y transversal en el que participaron 507 trabajadores del hospital, a los cuales se les practicó una encuesta personalizada.Resultados: Participaron 380 (75 %) mujeres y 127 (25 %) hombres con una edad 39,2 ±10 años. El 51,1% son universitarios. Menos de la mitad consumen medicamentos o sufren de enfermedades. La mayoría no fuma e ingiere menos de 2 litros de agua/día. El 73,4 % evacúa diariamente, una vez/día y en la mañana, con heces tipo 3. 12 (2,36 %) presentan constipación según ROMA III, edad 39 años, femenino, la mayoría son TSU y enfermeras (p=0,03) e ingieren menos de 2 litros de agua/día, consumen algunas veces frutas y cereales y muy poco realizan ejercicios. Los síntomas predominantes fueron: dispepsia, dolor y distensión abdominal, dolor al evacuar y sensación de evacuación incompleta. Todos evacuan heces tipo 1 y el 41,66 % empleo laxantes. El 50 % manifestó algún grado de alteración de su calidad de vida.Conclusiones: El hábito intestinal de nuestra población se caracterizó por frecuencia evacuatoria diaria, una vez/día; heces tipo 3 y 4, sin sensación de evacuación incompleta, dolor o esfuerzo al evacuar.

Introduction: Bowel function and related disorders are common consulting problems. Because in Venezuela we lack of adequate information to define both bowel normal habit and the frequency of its alterations in our population we decided to perform this study. Objective: To assess bowel function of the “Dr. Domingo Luciani” hospital staff between April and September of 2008.Method: In a descriptive and transversal study, we apply a personalized survey to all the hospital staff who participated.Results: 507 hospital staff members were studied. 380 females (75 %) /127 males (25 %). The average age was 39,2 ±10 years. The 51,1% have an universitary degree, and less than half used medications or suffer diseases. Most of them were no smokers and drink less than 2 liters of water per day. The 73,4 % of the subjects passed a stool on a daily basis, in the morning with feces type 3. 12 patients (2,36 %) had constipation according to Roma III criteria. In those subjects predominant symptoms were: dyspepsia, abdominal pain and bloating, pain during evacuation and incomplete evacuation sensation. All had a type I stool pattern and the 41,66 % used laxatives regularly. The 50 % exhibit some degree of quality of life impairment. Average age in this group was 39 years, female sex, nurses and Higher University Technicians (p=0, 03). They drink less than 2 liters of water/day, sometimes consume fruits and cereals and do very little exercise

The bowel habits of adolescents in Nigeria.

Background: The implications of defaecation patterns to health are important. The abnormalities can be readily recognized and treated only if the normal pattern is known. Methods: This cross sectional study involved 1115 adolescents enrolled using a stratified multi-stage random sampling technique. A self-administered and semi-structured questionnaire was used to obtain information on stool frequency, volume, colour and consistency. Data were compared between low and high across socioeconomic strata. Results: There were 481 males (overall mean age: 15.2+1.9 years). Participants were on mixed carbohydrate rich diet with both high and low fibre content.. Stool frequency was at least once daily in 77.3%, once in alternate days (17.4%) and once in >3days (5.3%). There was no association between stool frequency and gender (p=0.141) or age (p=0.345). More participants from the high (64.9%) than the low (35.1%) social classes opened their bowels once in >3days (p=0.048). More males produced larger stool volumes (>200ml) than females, (p=0.000). More than half (50.5%) of the participants reported passing brownish stool, 46.3% yellow stool and 3.2% greenish brown stool. Passage of soft stool was reported by 74.9% of the participants. Overall, 3.4% of participants had passed blood in their stool at some time. Conclusion: Majority of Nigerian adolescents passed 25-200 ml of soft stool atleast once daily and age and gender did not affect stool frequency. High socioeconomic status was associated with passage of hard stool and less frequent bowel opening. This data could facilitate early recognition of deviation from normal bowel habits in Nigerian adolescents.

Weight,Length and Bristol′s Scale of Normal Children / 实用儿科临床杂志

Objective To investigate the weight,length and scale of normal children′ stools and discuss clinical signification.Met-(hods) The fresh stools of 60 normal children (male 34,female 26)were measured,classify the stools according to Bristol′s scale.Results 1.The average weight of stools in 60 cases was (109.53?52.00) g,of male was (123.79?55.87) g,of female was (90.12?(39.66)) g,there was significant difference between them (t=0.013 P0.05);3.The stools was classified into 7 group according to Bristol′s scale.From 1 grade to 6 grade were 3.30%,(5.10%),5.10%,64.40%,15.30% and 6.80%,respectively,but there was no 7 grade stools.Conclusion The weight,length and scales of normal children′s stools can be used as a sign to evaluate the clonic movement of children,especially in diagnosis and treatment of constipation and stools dryness