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CLINICAL REVIEW: Iain J D McCallum, Sarah Ong, and Mark Mercer-Jones Chronic constipation in adults BMJ 2009; 338: b831 [Full text]

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Chronic constipation: let's start from definition, first of all in elderly.

C. Pedrolli   (27 March 2009)

Bristol Stool Chart and Bristol Stool Form Scale

Kenneth W Heaton   (4 April 2009)

Chronic constipation: let's start from definition, first of all in elderly. 27 March 2009
C. Pedrolli, Consultant Nutritional Unit S. Chiara Hospital Via P. Orsi n. 1 38100 Trento, Italy Send response to journal: Re: Chronic constipation: let's start from definition, first of all in elderly.	In Mac Callum et Al interesting paper one of starting point is that Rome criteria are far from represent the all of constipation; that's particularly true when we speak about elderly and in particular of nursing home residents 1 where cognitive impairment is present to take away from Rome criteria their meaning. So I think we have to start from simple definition: and the one of Mac callum "any patients experiencing consistent difficulty with defecation" seems to me particularly fitted for nursing homes residents. 1. Pedrolli C. Chronic constipation in nursing homes: time to change speed?. Min Med Gastroenterol Dietol 2008;54(1):105 -106. Competing interests: None declared
Bristol Stool Chart and Bristol Stool Form Scale 4 April 2009
Kenneth W Heaton, Retired physician Claverham House, Claverham, Bristol BS49 4QD Send response to journal: Re: Bristol Stool Chart and Bristol Stool Form Scale	In their review of constipation, McCallum et al commend the Bristol Stool Chart for monitoring the progress of treatment and attribute the Chart to myself and SJ Lewis1. This attribution is incorrect. The mistake is understandable since it appears in Wikipedia, where I have tried and failed to amend the entry. In fact, the Chart was developed by me alone (but named as such by others) as a visual equivalent to the well- established Bristol Stool Form Scale, a transit time-sensitive list of seven verbal descriptors which colleagues and I had published in 19902. The first 'proper' publication of the visual Chart (accompanied by the verbal Scale) was in 1999 in a booklet for the general public3. In the same year, it appeared in a book for GPs4. I am not aware of the Chart having been published in an academic journal. All published validations are based on the verbal Scale, not on the visual Chart, and one of these was indeed a paper by SJ Lewis and myself5. It so happens that this study is relevant to the review of McCallum et al because it demonstrated the responsiveness of the Bristol Scale to laxatives and constipating agents. I am glad to say that a paper validating the Chart against the Scale is now in press -in English - in Revista Espanola de Enfermedades Digestivas (D Parés et al, Barcelona University Hospital Colorectal Surgery Unit). 1 McCallum IJD, Ong S, Mercer-Jones M, Chronic constipation in adults. BMJ 2009;338:b831 (28 March 2009). 2. O’Donnell LJD, Virjee J, Heaton KW, Detection of pseudodiarrhoea by simple clinical assessment of intestinal transit rate. BMJ 1990;300:439- 40. 3 Heaton KW, Understanding Your Bowels, 3rd edn. Banbury: Family Doctor Publications, 1999. 4 Heaton KW, Thompson WG, Irritable Bowel Syndrome, Oxford: Health Press, 1999. 5 Lewis SJ, Heaton KW, Stool form scale as a useful guide to intestinal transit timeScand J Gastroent 1997;32:920-4. Competing interests: None declared