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.