World journal of clinical pediatrics · 2026
Evaluating the role of the Bristol stool chart in diagnosing functional constipation in pediatric populations.
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Ounboontham Kriangsak, Ngoenmak Thitima
Аннотация
BACKGROUND: Functional constipation (FC) is a common condition among children worldwide. Although the Rome IV criteria are diagnostic standard, evaluating infants and toddlers can be challenging. The Bristol stool chart (BSC) is a simple tool for describing stool consistency, but its diagnostic accuracy in young children is uncertain.
AIM: To compare the diagnostic performance of the BSC and Rome IV criteria in children under four years.
METHODS: A prospective cross-sectional study was conducted from June 2025 to October 2025 among children aged 6 months to 4 years attending well-child visits at the Hospital. Parents completed validated Thai versions of the Rome IV questionnaire and the BSC. FC was diagnosed using the Rome IV criteria. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the BSC were calculated.
RESULTS: Among 275 children enrolled, 43 (15.6%) met the Rome IV criteria for FC. The FC group had a significantly higher mean age than the non-FC group (30.1 ± 11.9 months vs 21.2 ± 12.2 months, P < 0.001). A family history of constipation was associated with increased FC prevalence (P = 0.017). On the BSC, stool types 1-2 indicated constipation. Compared with the Rome IV criteria, the BSC demonstrated sensitivity of 48.8%, specificity of 98.3%, PPV of 84.0%, and NPV of 91.2%.
CONCLUSION: The BSC shows high specificity but low sensitivity in young children; stool types 1-2 support FC and are best used to confirm diagnosis alongside the Rome IV criteria.
AIM: To compare the diagnostic performance of the BSC and Rome IV criteria in children under four years.
METHODS: A prospective cross-sectional study was conducted from June 2025 to October 2025 among children aged 6 months to 4 years attending well-child visits at the Hospital. Parents completed validated Thai versions of the Rome IV questionnaire and the BSC. FC was diagnosed using the Rome IV criteria. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the BSC were calculated.
RESULTS: Among 275 children enrolled, 43 (15.6%) met the Rome IV criteria for FC. The FC group had a significantly higher mean age than the non-FC group (30.1 ± 11.9 months vs 21.2 ± 12.2 months, P < 0.001). A family history of constipation was associated with increased FC prevalence (P = 0.017). On the BSC, stool types 1-2 indicated constipation. Compared with the Rome IV criteria, the BSC demonstrated sensitivity of 48.8%, specificity of 98.3%, PPV of 84.0%, and NPV of 91.2%.
CONCLUSION: The BSC shows high specificity but low sensitivity in young children; stool types 1-2 support FC and are best used to confirm diagnosis alongside the Rome IV criteria.