Validity and reliability of the Bristol Stool Form Scale in healthy adults and patients with diarrhoea‐predominant irritable bowel syndrome

Blake, M. R.; Raker, J. M.; Whelan, K.

doi:10.1111/apt.13746

Cited by 501Gastrointestinal motility and disordersPelvic floor disorders treatmentsHealth Education and Validation

Validity and reliability of the Bristol Stool Form Scale in healthy adults and patients with diarrhoea‐predominant irritable bowel syndrome

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Blake, M. R., Raker, J. M., Whelan, K.·2016·Alimentary Pharmacology & Therapeutics

DOI 10.1111/apt.13746

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Abstract

Summary: Background: The Bristol Stool Form Scale (BSFS) is a 7‐point scale used extensively in clinical practice and research for stool form measurement, which has undergone limited validity and reliability testing. Aim: To determine the validity and reliability of the BSFS in measuring stool form in healthy adults and patients with diarrhoea‐predominant irritable bowel syndrome (IBS‐D). Methods: One hundred and sixty‐nine healthy volunteers provided a stool sample and used the BSFS to classify stool form, which was compared with measured stool water content and with values from 19 patients with IBS‐D. Eighty‐six volunteers used the BSFS to classify 26 stool models to determine accuracy and reliability. Results: Volunteers’ classifications of stool type correlated with stool water (Spearman's rho = 0.491, P < 0.001), which increased in hard (Types 1–2), normal (Types 3–5) and loose stools (Types 6–7) (P < 0.001). The BSFS detected differences in stool form between healthy volunteers (mean 3.7, s.d. 1.5) and IBS‐D patients (mean 5.0, s.d. 1.2) (P < 0.001). Overall, 977/1204 (81%) stool models were correctly classified (substantial accuracy, κ = 0.78), although <80% of Types 2, 3, 5 and 6 were classified correctly. On 852/1118 (76%) occasions, volunteers classified covert duplicate models to the same stool type (substantial reliability, κ = 0.72), but with only moderate reliability for Types 2 (63%, κ = 0.57) and 3 (62%, κ = 0.55). Conclusions: The BSFS demonstrated substantial validity and reliability, although difficulties arose around clinical decision points (Types 2, 3, 5, 6) that warrant investigation in larger clinical populations. Potential for improving validity and reliability through modifications to the BSFS or training in its use should be explored.

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Lifestyle and Risk Factors in Hemorrhoidal Disease
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Antipsychotic-Induced Constipation: A Review of the Pathogenesis, Clinical Diagnosis, and Treatment
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Effect of Lacticaseibacillus paracasei strain Shirota supplementation on clinical responses and gut microbiome in Parkinson's disease
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A Multicenter Randomized Controlled Trial of Microbiome-Based Artificial Intelligence-Assisted Personalized Diet vs Low-Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols Diet: A Novel Approach for the Management of Irritable Bowel Syndrome
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The Relationship between Low Serum Vitamin D Levels and Altered Intestinal Barrier Function in Patients with IBS Diarrhoea Undergoing a Long-Term Low-FODMAP Diet: Novel Observations from a Clinical Trial
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Multicenter prospective study showing a high gastrointestinal symptom burden in cystic fibrosis
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Efficacy and safety of Gelsectan for diarrhoea‐predominant irritable bowel syndrome: A randomised, crossover clinical trial
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Spore-forming Bacillus coagulans SNZ 1969 improved intestinal motility and constipation perception mediated by microbial alterations in healthy adults with mild intermittent constipation: A randomized controlled trial
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Prebiotic Galactooligosaccharide Supplementation in Adults with Ulcerative Colitis: Exploring the Impact on Peripheral Blood Gene Expression, Gut Microbiota, and Clinical Symptoms
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Restoring an adequate dietary fiber intake by inulin supplementation: a pilot study showing an impact on gut microbiota and sociability in alcohol use disorder patients
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Efficacy and Findings of a Blinded Randomized Reintroduction Phase for the Low FODMAP Diet in Irritable Bowel Syndrome
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Supplementing Dietary Fibers With a Low FODMAP Diet in Irritable Bowel Syndrome: A Randomized Controlled Crossover Trial
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A Dietary Intervention High in Green Leafy Vegetables Reduces Oxidative DNA Damage in Adults at Increased Risk of Colorectal Cancer: Biological Outcomes of the Randomized Controlled Meat and Three Greens (M3G) Feasibility Trial
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Psychological and Gastrointestinal Symptoms of Patients with Irritable Bowel Syndrome Undergoing a Low-FODMAP Diet: The Role of the Intestinal Barrier
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A Randomised, Controlled Trial: Effect of a Multi-Strain Fermented Milk on the Gut Microbiota Recovery after Helicobacter pylori Therapy
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Puerarin from Pueraria lobata alleviates the symptoms of irritable bowel syndrome-diarrhea
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Evaluation of two laboratory model methods for diarrheal irritable bowel syndrome
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Perceptions of Constipation Among the General Public and People With Constipation Differ Strikingly From Those of General and Specialist Doctors and the Rome IV Criteria
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Changes in bowel function following exoskeletal-assisted walking in persons with spinal cord injury: an observational pilot study
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Indian consensus statements on irritable bowel syndrome in adults: A guideline by the Indian Neurogastroenterology and Motility Association and jointly supported by the Indian Society of Gastroenterology
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Nutrition, Physical Activity and Supplementation in Irritable Bowel Syndrome
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A high prevalence of chronic gastrointestinal symptoms in adults with cystic fibrosis is detected using tools already validated in other GI disorders
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Association between Altered Blood Parameters and Gut Microbiota after Synbiotic Intake in Healthy, Elderly Korean Women
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Stool frequency and form and gastrointestinal symptoms differ by day of the menstrual cycle in healthy adult women taking oral contraceptives: a prospective observational study
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How is small bowel permeability in endometriosis patients? a case control pilot study
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The effect of faecal microbiota transplantation on abdominal pain, stool frequency, and stool form in patients with moderate-to-severe irritable bowel syndrome: results from a randomised, double-blind, placebo-controlled study
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The impact of almonds and almond processing on gastrointestinal physiology, luminal microbiology, and gastrointestinal symptoms: a randomized controlled trial and mastication study
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The Effect of the Low FODMAP Diet on Gastrointestinal Symptoms, Behavioral Problems and Nutrient Intake in Children with Autism Spectrum Disorder: A Randomized Controlled Pilot Trial
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Prevalence and correlates of REM sleep behaviour disorder in patients with major depressive disorder: a two-phase study
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Inaccuracy of patient‐reported descriptions of and satisfaction with bowel actions in irritable bowel syndrome
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Modulation of NLRP3 Inflammasome Attenuated Inflammatory Response Associated to Diarrhea-Predominant Irritable Bowel Syndrome
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Designing the GALAXY study: Partnering with the cystic fibrosis community to optimize assessment of gastrointestinal symptoms
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Relationships Between Rapid Eye Movement Sleep Behavior Disorder and Parkinson’s Disease: Indication from Gut Microbiota Alterations
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Adipose Tissue-Derived Biomarkers of Intestinal Barrier Functions for the Characterization of Diarrhoea-Predominant IBS
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Microbiota alterations are related to migraine food triggers and inflammatory markers in chronic migraine patients with medication overuse headache
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Impact of Saccharomyces boulardii CNCM I-745 on Bacterial Overgrowth and Composition of Intestinal Microbiota in Diarrhea-Predominant Irritable Bowel Syndrome Patients: Results of a Randomized Pilot Study
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Nopal fiber ( Opuntia ficus ‐ indica ) improves symptoms in irritable bowel syndrome in the short term: a randomized controlled trial
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Long‐term symptom severity in people with irritable bowel syndrome following dietetic treatment in primary care: A service evaluation
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Feasibility of Low Fermentable Oligosaccharide, Disaccharide, Monosaccharide, and Polyol Diet and Its Effects on Quality of Life in an Italian Cohort
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Validity of an observational assessment tool for multifaceted evaluation of faecal condition
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Roux-en-Y reconstruction alleviates radical gastrectomy-induced colitis via down-regulation of the butyrate/NLRP3 signaling pathway
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Effect of Ginger Root Powder on Gastrointestinal Bacteria Composition, Gastrointestinal Symptoms, Mental Health, Fatigue, and Quality of Life: A Double-Blind Placebo-Controlled Trial
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Improved Symptom Profiles and Minimal Inflammation in IBS-D Patients Undergoing a Long-Term Low-FODMAP Diet: A Lipidomic Perspective
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Dietary fiber deficiency as a component of malnutrition associated with psychological alterations in alcohol use disorder
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Gender-specific insights into the irritable bowel syndrome pathophysiology. Focus on gut dysbiosis and permeability
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Stool Consistency: Looking Beyond the Bristol Stool Form Scale
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Liver alterations are not improved by inulin supplementation in alcohol use disorder patients during alcohol withdrawal: A pilot randomized, double-blind, placebo-controlled study
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Efficacy of a Synbiotic Containing Lactobacillus paracasei DKGF1 and Opuntia humifusa in Elderly Patients with Irritable Bowel Syndrome: A Randomized, Double-Blind, Placebo-Controlled Trial
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Fecal Microbiota Signatures Are Not Consistently Related to Symptom Severity in Irritable Bowel Syndrome
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Diabetic gastroenteropathy: a pan-alimentary complication
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“Combined proximal and distal gastrointestinal symptoms can be assessed using the validated Gastrointestinal Symptom Rating Scale (GSRS) questionnaire, and faecal consistency can be assessed using the Bristol Stool Form Scale [69, 70].”
Evaluation of inter- and intra-variability in gut health markers in healthy adults using an optimised faecal sampling and processing method
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Metagenomic estimation of absolute bacterial biomass in the mammalian gut through host-derived read normalization
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The effect of photobiomodulation therapy on the management of chronic idiopathic large-bowel diarrhea in dogs
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A Smartphone Application Using Artificial Intelligence Is Superior To Subject Self-Reporting When Assessing Stool Form
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Effect of Oral Intake of Lactiplantibacillus plantarum APsulloc 331261 (GTB1TM) on Diarrhea-Predominant Irritable Bowel Syndrome: A Randomized, Double-Blind, Placebo-Controlled Study
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Specific gut microbiota alterations in essential tremor and its difference from Parkinson’s disease
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Development of a new version of the Bristol Stool Form Scale: translation, content validity, face validity, and reliability of the Persian version
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Perspective: Assessing Tolerance to Nondigestible Carbohydrate Consumption
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Modest Conformity Between Self-Reporting of Bristol Stool Form and Fecal Consistency Measured by Stool Water Content in Irritable Bowel Syndrome and a FODMAP and Gluten Trial
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Short- and Long-Term Effects of a Prebiotic Intervention with Polyphenols Extracted from European Black Elderberry—Sustained Expansion of Akkermansia spp.
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The Effect of Bacillus subtilis DE111 on the Daily Bowel Movement Profile for People with Occasional Gastrointestinal Irregularity
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The Effect of Exoskeletal-Assisted Walking on Spinal Cord Injury Bowel Function: Results from a Randomized Trial and Comparison to Other Physical Interventions
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Paeoniflorin alleviates inflammatory response in IBS-D mouse model via downregulation of the NLRP3 inflammasome pathway with involvement of miR-29a
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Procedures in Fecal Microbiota Transplantation for Treating Irritable Bowel Syndrome: Systematic Review and Meta-Analysis
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Role of a berberine-based nutritional supplement in reducing diarrhea in subjects with functional gastrointestinal disorders
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End-to-end donor screening and manufacturing controls: complementary quality-based strategies to minimize patient risk for donor-derived microbiome therapeutics
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Authors: Blake, M. R., Raker, J. M., & Whelan, K.
Affiliations: King's College London (GB)
Corresponding author: Whelan, K.
ORCID: Blake, M. R.
Whelan, K.
Venue: Alimentary Pharmacology & Therapeutics
Publisher: Wiley
Published: 2016-08-05
Volume: 44
Issue: 7
Pages: 693-703
ISSN: 0269-2813 (ISSN-L)
1365-2036
DOI: 10.1111/apt.13746
OpenAlex: W2504563199
Cited by: 495
References: 50
Citations by year: 2026: 57 · 2025: 71 · 2024: 83 · 2023: 63 · 2022: 69 · 2021: 66 · 2020: 40 · 2019: 28 · 2018: 12 · 2017: 6
FWCI: 16.79
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Alimentary Pharmacology & Therapeutics (publishedVersion)
PubMed (publishedVersion)
Own your potential (DEAKIN) (submittedVersion)
Figshare (submittedVersion)
Topics: Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
Social Sciences › Education › Health Education and Validation
Keywords: Bristol Stool Form Scale, diarrhea-predominant irritable bowel syndrome, stool water content, measurement validity, inter-rater reliability, healthy adults
MeSH terms: Adult, Diarrhea, Feces, Female, Humans, Male, Middle Aged, Reproducibility of Results, Irritable Bowel Syndrome, Young Adult

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Validity and reliability of the Bristol Stool Form Scale in healthy adults and patients with diarrhoea‐predominant irritable bowel syndrome

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