PP05 - ASSOCIATION OF STOOL FORM AND COLONIC TRANSIT, A REAL-LIFE RETROSPECTIVE STUDY. #35

PO Tan1, KK Zulkifli1,2, SR Hassim1,3, SN Muhamad1, A Abdul Aziz1, N Mustaffa4, YY Lee1,4

1 GI Function & Motility Unit, Hospital Universiti Sains Malaysia, Kota Bharu, Malaysia.
2 Faculty of Medicine, Universiti Teknologi Mara, Sungai Buloh, Malaysia
3 Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.
4School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia.

Objective(s):
Stool form (Bristol Stool Form Scale or BSFS) is often used as clinical surrogate for gut transit. Colonic transit time correlates with BSFS 1-2 in the Western (United States) population but BSFS 1-3 in the Asian (India and Thailand) population. Our study aimed to determine the predictive value of BSFS on colonic transit in Malaysian patients with functional constipation (FC).

Methodology:
Adult patients with FC based on the Rome III criteria were included. All had their BSFS recorded at baseline and colonic transit assessed using single Sitzmark® capsule (24 radiopaque markers). After baseline abdominal X-ray was performed, patients swallowed the capsule and abdominal X-ray repeated 120 hours later (1). Retention of >5 radiopaque markers on Day 5 was interpreted as slow colonic transit.

Results:
Of 45 recruited patients, the mean age was 47 ± 23 years old and 71% were females. Distribution of BSFS is shown in Figure A. Median BSFS was 3 and 66.7% had delayed colonic transit. BSFS 1-2 and BSFS 1-3 were present in 46.7% and 62.2% respectively. For prediction of slow transit, with BSFS 1-2, sensitivity was 60%, specificity 60%, PPV 42.9% and NPV 75% whereas for BSFS 1-3, the sensitivity was 80%, specificity 46.7%, PPV 42.9% and NPV 82.4% (Figure B). No significant association with delayed colonic transit was found for BSFS 1-2 (p=0.226) and BSFS 1-3 (p=0.11).

Discussion and Conclusions
BSFS 1-2 and BSFS 1-3 do not predict delayed transit in our population. It could be due to variability of day-to-day dietary preferences in a multicultural society like Malaysia. It also highlighted the importance of performing colonic transit test, rather than using BSFS alone to predict slow transit constipation in our population.

Reference:
(1) Kim ER, Rhee PL. How to interpret a functional or motility test - colon transit study. J Neurogastroenterol Motil. 2012;18(1):94-99.