Are the definitions for chronic diarrhoea adequate? Evaluation of two different definitions in patients with chronic diarrhoea. Issue 4 (August 2015)

• Record Type: Journal Article
• Authors: Stotzer, Per-Ove; Abrahamsson, Hasse; Bajor, Antal; Kilander, Anders; Sadik, Riadh; Sjövall, Henrik; Simrén, Magnus
• Is Part Of: United European Gastroenterology journal. Volume 3:Issue 4(2015:Aug.)
• Page Start: 381
• Page End: 386
• Publication Date: 2015-08
• Subjects: Diarrhoea -- definition of diarrhoea -- investigation of diarrhoea -- bile acid diarrhoe -- microscopic colitis; Gastroenterology -- Periodicals; Periodicals; 616.33005
• DOI: 10.1177/2050640615580219
• Languages: English
• ISSNs: 2050-6406

Abstract

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.