Abstract
Purpose
Limited data are available to guide the use of abdominal radiographs in the setting of constipation, especially in adults. Anecdotally, there has been a recent increase in such examinations. We sought to determine ordering trends for abdominal radiographs ordered to assess constipation, as well as to better understand referring clinician and radiologist opinion on such examinations.
Methods
We conducted a retrospective review of all abdominal radiographs performed between 2004 and 2014 at our institution with a primary indication of constipation. We also surveyed clinicians and radiologists regarding their opinions and practices involving such examinations.
Results
Constipation radiograph volume increased by approximately 56% over the 10-year period, while volume of all other abdominal radiographs decreased. Growth was greatest in adult females. Both radiologists and clinicians agree that constipation is a clinical diagnosis and are neutral as to whether radiographs help make the diagnosis. Clinicians somewhat agree that radiographs are helpful in determining management and find quantitation of stool burden within the radiology report helpful. Radiologists tend to find radiographs inaccurate at quantifying stool burden. Clinicians tend to agree that the increasing use of radiographs for constipation is appropriate while radiologists disagree. Education on these trends did not affect the intended future ordering practice of referring clinicians.
Conclusions
Constipation abdominal radiograph volume has disproportionately increased, especially in adult women. Clinicians and radiologists agree that constipation is a clinical diagnosis. Otherwise, the groups tend to have differing opinions on the utility of such examinations. Clinicians indicated no intention to change their ordering practices. Further investigation is needed to better define the role of imaging for this indication, including how the radiologist may best interpret and report such examinations.
Similar content being viewed by others
References
Loening-Baucke V (1993) Chronic constipation in children. Gastroenterology 105(5):1557–1564
Shah ND, Chitkara DK, Locke GR, Meek PD, Talley NJ (2008) Ambulatory care for constipation in the United States, 1993-2004. Am J Gastroenterol 103(7):1746–1753. https://doi.org/10.1111/j.1572-0241.2008.01910.x
Higgins PDR, Johanson JE (2004) Epidemiology of constipation in North America: a systematic review. Am J Gastroenterol 99(4):750–759. https://doi.org/10.1111/j.1572-0241.2004.04114.x
Hyman PE, Milla PJ, Benninga MA, et al. (2006) Childhood functional gastrointestinal disorders: neonate/toddler. Gastroenterology 130(5):1519–1526. https://doi.org/10.1053/j.gastro.2005.11.065
Rasquin A, Di Lorenzo C, Forbes D, et al. (2006) Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology 130(5):1527–1537. https://doi.org/10.1053/j.gastro.2005.08.063
Longstreth GF, Thompson WG, Chey WD, et al. (2006) Functional bowel disorders. Gastroenterology 130(5):1480–1491. https://doi.org/10.1053/j.gastro.2005.11.061
Leech SC, McHugh K, Sullivan PB (1999) Evaluation of a method of assessing faecal loading on plain abdominal radiographs in children. Pediatr Radiol 29(4):255–258. https://doi.org/10.1007/s002470050583
Barr RG, Levine MD, Wilkinson RH, Mulvihill D (1979) Chronic and occult stool retention: a clinical tool for its evaluation in school-aged children. Clin Pediatr (Phila) 18 (11):674, 676, 677–679, passim. https://doi.org/10.1177/000992287901801103
Blethyn AJ, Verrier Jones K, Newcombe R, Roberts GM, Jenkins HR (1995) Radiological assessment of constipation. Arch Dis Child 73(6):532–533
Nagaviroj K, Yong WC, Fassbender K, Zhu G, Oneschuk D (2011) Comparison of the Constipation Assessment Scale and plain abdominal radiography in the assessment of constipation in advanced cancer patients. J Pain Symptom Manag 42(2):222–228. https://doi.org/10.1016/j.jpainsymman.2010.11.019
Reuchlin-Vroklage LM, Bierma-Zeinstra S, Benninga MA, Berger MY (2005) Diagnostic value of abdominal radiography in constipated children: a systematic review. Arch Pediatr Adolesc Med 159(7):671–678. https://doi.org/10.1001/archpedi.159.7.671
Starreveld JS, Pols MA, Van Wijk HJ, et al. (1990) The plain abdominal radiograph in the assessment of constipation. Z Gastroenterol 28(7):335–338
Moylan S, Armstrong J, Diaz-Saldano D, et al. (2010) Are abdominal X-rays a reliable way to assess for constipation? J Urol 184(4 Suppl):1692–1698. https://doi.org/10.1016/j.juro.2010.05.054
Pensabene L, Buonomo C, Fishman L, Chitkara D, Nurko S (2010) Lack of utility of abdominal X-rays in the evaluation of children with constipation: comparison of different scoring methods. J Pediatr Gastroenterol Nutr 51(2):155–159. https://doi.org/10.1097/MPG.0b013e3181cb4309
NCCfWsaCsH (UK) (2010) Constipation in children and young people: diagnosis and management of idiopathic childhood constipation in primary and secondary care. In: National Institute for Health and Clinical Excellence: Guidance (ed) NICE clinical guidelines, vol. 99. London: RCOG Press
Tabbers MM, DiLorenzo C, Berger MY, et al. (2014) Evaluation and treatment of functional constipation in infants and children: evidence-based recommendations from ESPGHAN and NASPGHAN. J Pediatr Gastroenterol Nutr 58(2):258–274. https://doi.org/10.1097/mpg.0000000000000266
Freedman SB, Rodean J, Hall M, et al. (2017) Delayed diagnoses in children with constipation: multicenter retrospective cohort study. J Pediatr . https://doi.org/10.1016/j.jpeds.2017.03.061
Bove A, Pucciani F, Bellini M, et al. (2012) Consensus statement AIGO/SICCR: diagnosis and treatment of chronic constipation and obstructed defecation (part I: diagnosis). World J Gastroenterol 18(14):1555–1564. https://doi.org/10.3748/wjg.v18.i14.1555
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors (J Reber, A McGauvran, and A Froemming) declare that they have no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Rights and permissions
About this article
Cite this article
Reber, J., McGauvran, A. & Froemming, A. Abdominal radiograph usage trends in the setting of constipation: a 10-year experience. Abdom Radiol 43, 2231–2238 (2018). https://doi.org/10.1007/s00261-018-1466-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-018-1466-7