Bristol Stool Form Scale reliability and agreement decreases when determining Rome III stool form designations.

Background: Rater reproducibility of the Bristol Stool Form Scale (BSFS), which categorizes stools into one of seven types, is unknown. We sought to determine reliability and agreement by individual stool type and when responses are categorized by Rome III clinical designation as normal or abnormal (constipation or diarrhea).

Methods: Thirty-four gastroenterology providers from three institutions rated 35 stool photographs using the BSFS.

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