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

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.

Calcium Polycarbophil in the Management of Fecal Incontinence.

Background: Few clinical studies have assessed the efficacy of calcium polycarbophil that is currently recommended as an ideal and initial bulk-forming agent in patients with fecal incontinence. Aims: The aim of this study was to evaluate the short-term outcomes of calcium polycarbophil administration to patients with fecal incontinence due to a range of etiologies. Study Design: This was a retrospective review of a single-institution experience. Methodology: In total, 223 patients treated with calcium polycarbophil were enrolled. Efficacy measures included changes in the Cleveland Clinic Incontinence Score and the Bristol Stool Form Scale. Results: Of the 223 patients who were enrolled, 195 were available for final analysis. Among the 195 patients, 15 (7.7%) experienced side effects; the most common side effects were constipation and hard stools. One month after the start of treatment, the mean Cleveland Clinic Incontinence Score decreased significantly compared with baseline (11.2±4.0 vs. 5.7±5.0, P = < .001). The mean stool consistency decreased significantly, with patients reporting more formed stools by the Bristol Stool Form Scale at 1 month than at baseline (4.4±1.5 vs. 3.9±1.1, P = < .001). Conclusions: Our findings suggest that monotherapy with calcium polycarbophil appears to be a safe and beneficial approach in the management of fecal incontinence.

The Correlation of Verbal Expression of Stool, Bristol Stool Form Scale and Colon Transit Time for Children with Gastrointestinal Symptoms / 대한소아소화기영양학회지

PURPOSE: The aim of this study was to evaluate the correlation among descriptions regarding one's stool, Bristol stool form scale and colon transit time (CTT) in children with gastrointestinal symptoms, along with the clinical significance of Bristol stool form scale. METHODS: 489 patients treated in the pediatric department of Severance hospital with gastrointestinal symptoms between May 2002 to May 2004 were included. We analyzed their age, sex, verbal descriptions of stool, Bristol stool form types, and CTT measured by Metcalf's method. RESULTS: 116 children were under 5 years of age, 202 children between 5.1~10, and 171 children 10 years of age or older. Their mean age was 8.2+/-3.9 years. Stools were described as loose in 65 children (13.3%), normal in 221 (45.2%), hard in 188 (38.4%), and mixed (loose+hard) in 15 (3.1%). According to Bristol stool form scale, 57 children(11.7%) were classified as type 1, 66 (13.5%) as type 2, 203 (41.5%) as type 3, 109 (22.3%) as type 4, 36 (7.4%) as type 5, 18 (3.7%) as type 6, and 1 (0.2%) as type 7. Their mean CTT was checked 35.9+/-19.5 hours. Though no significant relationship was observed between age and CTT (p=0.4), a significant relationship was noted among patient's stool description, Bristol stool form scale and CTT (p<0.001). However, concordance between stool description and Bristol stool form was relatively low in the loose stool group (29%) and normal stool group (37%) while high in the hard stool group (87%). CONCLUSION: Bristol stool form scale could be used in the estimation of CTT in clinical practice.