Fecograph: A graphical representation of daily stool forms to subtype irritable bowel syndrome in office practice

BACKGROUND AND AIM: Interpreting stool form diaries for subtyping patients with the irritable bowel syndrome (IBS) is cumbersome; a picture showing a trend would be easier to interpret. METHODS: Fifty‐one consecutive adults with IBS (median age 35.5 years; 47 men), diagnosed using the Rome III criteria, were given a picture of the Bristol stool form scale (BSFS) and asked to record their stool frequency and form for 7 days. The numbers were plotted by a technician as dots on a chart. On the y axis, BSFS category 4 was marked as 0, harder stools as +1 to +3, and softer stools as −1 to −3; each bowel movement was represented on the x axis. A line graph was plotted by connecting the dots. Each “fecograph” was then given for visual interpretation to three gastroenterologists (observers). When most readings appeared to be 0, +1, or −1, it was to be reported as normal; most above +1 as IBS‐constipation (IBS‐C); most below −1 as IBS‐diarrhea (IBS‐D); and readings crossing 1 on either side as IBS‐mixed (IBS‐M). If no clear trend was noted, it was IBS‐unclassified (IBS‐U). Each observer reported all graphs in different orders twice, at 1‐month intervals; thus, 306 reports were available. Interclass correlation coefficient (ICC) was calculated. RESULTS: Eighteen patients had IBS‐C, 13 IBS‐D, 4 IBS‐M, and 16 IBS‐U. The 51 fecographs were reported in mean 20 min 36 s. ICC for intra‐ and interobserver reliability was 0.62 (0.50–0.73). CONCLUSION: The fecograph is a reliable and easy‐to‐use tool to subtype patients with IBS.