There were likely both types of diarrhea affecting the patients in this study, with a resulting wide variety of fecal loading. In their discussion, the authors noted that this study did not distinguish between diarrhea as a global symptom and diarrhea suspected to be secondary to overflow from constipation. ![]() The authors noted that those with diarrhea and bowel leakage were no more likely to have fecal loading than those without these symptoms. Bloating in particular is a multifactorial symptom with many potential causes, requiring careful consideration of all relevant clinical data before attributing this symptom to constipation based on the results of abdominal X-ray. Fecal loading can be seen both in those with and without GI symptoms, indicating that the initial symptoms cannot definitively be tied to fecal loading in many cases. As the authors note, fecal loading was a very common finding, noted in 84% of individuals in this study (including 80% of those whose chief complaint was something other than constipation, and > 70% of those whose chief complaint was diarrhea), with the authors specifically noting that moderate fecal loading in multiple bowel compartments was most commonly noted in the radiographic report. As the first study to demonstrate a relationship between radiographic fecal burden and clinically reported patient symptoms in an adult outpatient population, this study does clearly advance clinical practice.ĭespite the demonstrated association between radiographic fecal burden and clinical constipation and bloating symptoms, the exact clinical implication of a radiographic finding of fecal loading still needs to be interpreted cautiously, and on a case-by-case basis. ![]() Although constipation remains a clinical rather than radiographic diagnosis, abdominal X-ray can nonetheless serve as a helpful additional data point in clarifying the clinical picture in cases of uncertainty. Within this narrower population, the authors did indeed find clinical utility to this test, specifically noting that constipated patients were significantly more likely to have fecal loading compared with diarrhea patients, and that a complaint of bloating was also associated with fecal loading. The selection of outpatients who reported GI symptoms was a unique aspect of this study compared to other adult studies performed in the emergency room setting. ![]() This study reported data exclusively gathered on adult outpatients and did not utilize a formal scoring system to assess fecal burden. Among demographic factors, BMI was associated with fecal loading, with each one unit increase in BMI associated with an 8% increase in the odds of radiographic fecal loading. Among other listed symptoms, bloating was the only one noted to be an independent predictor of fecal loading. Constipation was not an independent predictor of fecal loading when listed as a symptom rather than as a chief complaint. Key findings were that a chief complaint of constipation was an independent predictor of having fecal loading on multiple logistic regression analysis, whereas chief complaints of “accidental bowel leakage” or “other” were not independent predictors of fecal loading (those with chief complaint of diarrhea served as the reference group in this analysis). The vast majority of these 319 patients (84.0%) had radiographic documentation of fecal loading. The authors distinguished between cases in which the above symptoms were noted as the chief complaint, versus as a listed symptom. ![]() The authors investigated the association between radiographic fecal burden (which was determined on the basis of “fecal loading” or “fecal matter” in the radiology report) and clinically reported patient symptoms, focusing on clinical symptoms of constipation, diarrhea, bloating, and accidental bowel leakage. reported a retrospective study of 319 adult patients (median age 57.9 years, and predominantly female) who were seen by a gastroenterologist or urogynecologist at the University of Michigan between 20, and who underwent an abdominal X-ray for assessment of fecal loading. In this issue of Digestive Diseases and Sciences, Pleasant et al.
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