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Key Points 2 Copyright Rome Foundation, Bristol Stool Form Scale developed by Dr Ken Heaton, University of Bristol, UK. e Bristol Stool Form Scale (BSFS) is a useful tool to evaluate bowel habit. e BSFS has been shown to be a reliable surrogate marker for colonic transit. Figure 1A. Bristol Stool Form Scale Type 1 Separate hard lumps, like nuts (hard to pass) Type 2 Sausage-shaped, but lumpy Type 3 Like a sausage but with cracks on its surface Type 4 Like an Italian sausage or snake, smooth and so Type 5 So blobs with clear cut edges (passed easily) Type 6 Fluffy pieces with ragged edges, a mushy stool Type 7 Watery, no solid pieces. Entirely liquid Figure 1B. IBS Subtypes and Stool Form 25% of BM is the threshold for classification 100 75 50 25 0 25 50 75 100 IBS-C IBS-M IBS-U IBS-D % BM loose or watery % BM hard or lumpy Types 1 and 6 Types 6 and 7 Types 1 and 2 IBS subtypes should be established according to stool consistency, using the BSFS. IBS subtyping is more accurate when patients have ≥4 days of abnormal bowel habits per month. Bowel habit subtypes should be based on BSFS for days with abnormal bowel habits.

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