Physician-patient discordance in Bristol stool scale classification and overall IBS burden assessment.

Engel, Tal; Faibis, Chen; Tzur, May; Carter, Dan; Ben-Horin, Shomron; Ukashi, Offir · Am J Gastroenterol · 2026

case_control · Level III

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Abstract

The Bristol Stool Form Scale (BSFS) is widely used to assess stool consistency and subtype irritable bowel syndrome (IBS). Post-hoc analysis of a randomized trial comparing patient self-reported BSFS with physician-assessed BSFS. Baseline symptom severity and quality-of-life questionnaires were also collected. Agreement was poor across the 7-point scale (κ=-0.01, p=0.77) and after collapsing into three categories (κ=0.04, p=0.46), with concordance in only 18/64 cases (28%). Symptom severity and quality-of-life scores were similar between concordant and discordant groups. Patient-reported BSFS may not reliably reflect stool consistency or overall IBS burden, suggesting caution when using BSFS alone for monitoring or subtyping IBS.