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      A cross‐sectional study of stool form (using Bristol stool chart) in an urban South Indian population

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          Abstract

          Background

          There is paucity of data on Bristol stool form (BSF) in healthy South Indian residents.

          Aim

          To determine the BSF types and associated factors in an urban bowel health noncomplainant population.

          Methods

          This cross‐sectional study, performed using a self‐administered questionnaire among adult Chennai residents, compared BSF types by gender for various factors (age, occupation, bowel frequency, and defecation‐related abdominal pain). BSF types 1/2 and 6/7 were grouped as hard and loose stools, respectively. The statistical tests used were proportion test, χ 2, and Kruskal–Wallis tests ( P < 0.05 deemed significant).

          Results

          The study cohort of 1402 subjects included 748 (53.3%) men and a third each of professionals, semiprofessionals, and “non‐office goers” (homemakers, retirees, students, and unemployed). A total of 97% had daily bowel movement, and 8.5% reported defecation associated abdominal pain. The BSF types in decreasing prevalence were: Type 3 (35.6%), Type 4 (32.5%), Types 1 or 2 (20.5%), Type 5 (6.9%), and Types 6 or 7 (4.5%). On gender comparison, significantly more men passed hard ( P = 0.03) or loose stools ( P = 0.001), while more women passed Type 3 ( P = 0.0002). Loose stools in men were associated with abdominal pain ( P = 0.0035). Women passing hard or loose stool types were slightly older (median age in 30s vs. 20s in Types 3–5) and had reduced stool frequency ( P = 0.026: hard; P = 0.006: loose).

          Conclusions

          This South Indian noncomplainant cohort's most common stool types were BSF Types 3 and 4, with few gender variations in extreme stool types.

          Abstract

          This first study of stool form in south Indian noncomplainants shows that the majority pass Bristol stool Types 3 and 4. There are few gender variations only in the extremes of stool types.

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          Most cited references11

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          Defecation frequency and timing, and stool form in the general population: a prospective study.

          Because the range of bowel habits and stool types in the community is unknown we questioned 838 men and 1059 women, comprising 72.2% of a random stratified sample of the East Bristol population. Most of them kept records of three consecutive defecations, including stool form on a validated six point scale ranging from hard, round lumps to mushy. Questionnaire responses agreed moderately well with recorded data. Although the most common bowel habit was once daily this was a minority practice in both sexes; a regular 24 hour cycle was apparent in only 40% of men and 33% of women. Another 7% of men and 4% of women seemed to have a regular twice or thrice daily bowel habit. Thus most people had irregular bowels. A third of women defecated less often than daily and 1% once a week or less. Stools at the constipated end of the scale were passed more often by women than men. In women of child bearing age bowel habit and the spectrum of stool types were shifted towards constipation and irregularity compared with older women and three cases of severe slow transit constipation were discovered in young women. Otherwise age had little effect on bowel habit or stool type. Normal stool types, defined as those least likely to evoke symptoms, accounted for only 56% of all stools in women and 61% in men. Most defecations occurred in the early morning and earlier in men than in women. We conclude that conventionally normal bowel function is enjoyed by less than half the population and that, in this aspect of human physiology, younger women are especially disadvantaged.
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            Asian consensus on irritable bowel syndrome.

            Many of the ideas on irritable bowel syndrome (IBS) are derived from studies conducted in Western societies. Their relevance to Asian societies has not been critically examined. Our objectives were to bring to attention important data from Asian studies, articulate the experience and views of our Asian experts, and provide a relevant guide on this poorly understood condition for doctors and scientists working in Asia. A multinational group of physicians from Asia with special interest in IBS raised statements on IBS pertaining to symptoms, diagnosis, epidemiology, infection, pathophysiology, motility, management, and diet. A modified Delphi approach was employed to present and grade the quality of evidence, and determine the level of agreement. We observed that bloating and symptoms associated with meals were prominent complaints among our IBS patients. In the majority of our countries, we did not observe a female predominance. In some Asian populations, the intestinal transit times in healthy and IBS patients appear to be faster than those reported in the West. High consultation rates were observed, particularly in the more affluent countries. There was only weak evidence to support the perception that psychological distress determines health-care seeking. Dietary factors, in particular, chili consumption and the high prevalence of lactose malabsorption, were perceived to be aggravating factors, but the evidence was weak. This detailed compilation of studies from different parts of Asia, draws attention to Asian patients' experiences of IBS.
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              Epidemiological and clinical profile of irritable bowel syndrome in India: report of the Indian Society of Gastroenterology Task Force.

              To study the profile of irritable bowel syndrome (IBS), and the frequency of such symptoms among the general population, in India. In this prospective, multi-center study, data were obtained from 2785 patients with chronic lower gastrointestinal symptoms (complainants) with no alarm feature and negative investigations for organic causes visiting physicians at 30 centers, and from 4500 community subjects (non-complainants), using separate questionnaires. Most complainants were middle-aged (mean age 39.4 years) and male (1891; 68%). The common symptoms were: abdominal pain or discomfort (1958; 70%), abdominal fullness (1951; 70%); subjective feeling of constipation (1404 of 2656; 53%), or diarrhea (1252 of 2656, 47%), incomplete evacuation (2134; 77%), mucus with stools (1506; 54%), straining at stools (1271; 46%), epigastric pain (1364; 49%) and milk intolerance (906; 32%). Median stool frequency was similar in patients who felt they had constipation or those who felt they had diarrhea. Information to subtype symptoms using standard criteria was available in 1301 patients; of these, 507 (39%) had constipation-predominant IBS ( 3 3 stools/day) and 744 (57%) had indeterminate symptoms. Among non-complainants, most subjects reported daily defecation frequency of one (2520 [56%]) or two (1535 [34%]). Among non-complainants, 567 (12.6%) reported abdominal pain, 503 (11%) irregular bowel, 1030 (23%) incomplete evacuation, 167 (4%) mucus and 846 (18%) straining at stools; a combination of abdominal pain or discomfort relieved by defecation, and incomplete evacuation was present in 189/4500 (4.2%) community subjects. Most patients with IBS in India are middle-aged men, and have a sense of incomplete evacuation and mucus with stools. Abdominal pain or discomfort is frequent but not universal. Importantly, stool frequency was similar irrespective of whether the patients felt having constipation or diarrhea. Most (90%) non-complainant subjects had 1 or 2 stools per day; symptoms complex suggestive of IBS was present in 4.2% of community subjects.
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                Author and article information

                Contributors
                drsrinivasm@hotmail.com
                Journal
                JGH Open
                JGH Open
                10.1002/(ISSN)2397-9070
                JGH3
                JGH Open: An Open Access Journal of Gastroenterology and Hepatology
                Wiley Publishing Asia Pty Ltd (Melbourne )
                2397-9070
                25 April 2019
                December 2019
                : 3
                : 6 ( doiID: 10.1002/jgh3.v3.6 )
                : 464-467
                Affiliations
                [ 1 ] Department of Gastroenterology Gleneagles Global Health City Chennai India
                [ 2 ] Dr. Mohan's Diabetes Specialities Centre and Madras Diabetes Research Foundation Chennai India
                Author notes
                [*] [* ] Correspondence

                Dr Srinivas Melpakkam, Consultant Gastroenterologist, Gleneagles Global Health City, Chennai 600100, India. Email: drsrinivasm@ 123456hotmail.com

                Article
                JGH312189
                10.1002/jgh3.12189
                6891024
                e247d390-46cb-4312-8803-7577780531e4
                © 2019 The Authors. JGH Open: An open access journal of gastroenterology and hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 03 August 2018
                : 09 October 2018
                Page count
                Figures: 0, Tables: 4, Pages: 4, Words: 3138
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                December 2019
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.2 mode:remove_FC converted:04.12.2019

                bristol stool form,healthy,south india,urban
                bristol stool form, healthy, south india, urban

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