Skip to main content

Advertisement

SpringerLink
Log in

Colonic stool burden on computed tomography does not correlate with bowel habit: a cross-sectional study

  • Hollow Organ GI
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

Stool burden on abdominal radiographs is not reflective of constipation, perhaps because of variable fecal shadowing or limited inter-rater agreement. These limitations are hypothetically mitigated by computed tomography (CT). This research aimed (i) to evaluate whether bowel movement frequency, stool form, or a diagnosis of functional constipation correlate or associate with stool burden identified on CT, and (ii) to investigate whether physicians use CT in their assessment of a patients’ bowel function.

Methods

Patients attending for non-emergent abdominal CT imaging were invited to participate by completing a bowel questionnaire. Stool burden identified on imaging was determined and inter-rater reliability was evaluated in a subgroup of patients (n = 20). Descriptive and comparative analyses were performed. An online questionnaire evaluated the use of abdominal imaging in assessing patients’ bowel function in a cross-section of ordering physicians.

Results

The patient response rate was 19% (96/516). No clinically useful associations between fecal burden and stool form, bowel motion frequency, gastrointestinal symptoms or a diagnosis of constipation was identified. The physician response rate was 35% (33/94). Opportunistic use of data was more common than deliberate use. However, an abdominal radiograph or CT scan had been requested by 42% and 18% of physicians respectively to assess patient’s chronic bowel habit. Approximately 30% of physicians believed evidence supported this practice.

Conclusions

Physicians may use abdominal CT in their assessment of patients’ chronic bowel habits. However, objective assessment does not support this practice. Colonic stool burden does not correlate with patient-reported symptoms or a criteria-based diagnosis of constipation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

CT:

Computed tomography

CSI:

Cross-sectional imaging

References

  1. Longstreth, G.F., et al., Functional bowel disorders. Gastroenterology, 2006. 130(5): p. 1480-91.

    Article  Google Scholar 

  2. Lacy, B.E., et al., Bowel Disorders. Gastroenterology, 2016. 150(6): p. 1393-1407.e5.

    Article  Google Scholar 

  3. Dimidi, E., et al., Perceptions of Constipation Among the General Public and People With Constipation Differ Strikingly From Those of General and Specialist Doctors and the Rome IV Criteria. Am J Gastroenterol, 2019. 114(7): p. 1116-1129.

    Article  Google Scholar 

  4. Bellini, M., et al., Different perception of chronic constipation between patients and gastroenterologists. Neurogastroenterol Motil, 2018: p. e13336.

  5. Bharucha, A.E., J.H. Pemberton, and G.R. Locke, 3rd, American Gastroenterological Association technical review on constipation. Gastroenterology, 2013. 144(1): p. 218-38.

    Article  Google Scholar 

  6. Bewley, A., M.J. Clancy, and J.R. Hall, The erroneous use by an accident and emergency department of plain abdominal radiographs in the diagnosis of constipation. Arch Emerg Med, 1989. 6(4): p. 257-8.

    Article  CAS  Google Scholar 

  7. Kearney, R., et al., Emergency Provider Use of Plain Radiographs in the Evaluation of Pediatric Constipation. Pediatr Emerg Care, 2019. 35(9): p. 624-629.

    PubMed  Google Scholar 

  8. Driver, B.E., et al., Utility of plain abdominal radiography in adult ED patients with suspected constipation. Am J Emerg Med, 2019: p. 158377.

  9. de Lorijn, F., et al., The Leech method for diagnosing constipation: intra- and interobserver variability and accuracy. Pediatr Radiol, 2006. 36(1): p. 43-9.

    Article  Google Scholar 

  10. Freedman, S.B., et al., Pediatric Abdominal Radiograph Use, Constipation, and Significant Misdiagnoses. The Journal of Pediatrics, 2014. 164(1): p. 83-88.e2.

    Article  Google Scholar 

  11. Reuchlin-Vroklage, L.M., et al., Diagnostic value of abdominal radiography in constipated children: A systematic review. Archives of Pediatrics & Adolescent Medicine, 2005. 159(7): p. 671-678.

    Article  Google Scholar 

  12. Benninga, M.A., et al., Defaecation disorders in children, colonic transit time versus the Barr-score. Eur J Pediatr, 1995. 154(4): p. 277-84.

    Article  CAS  Google Scholar 

  13. Benninga, M.A., M.M. Tabbers, and R.R. van Rijn, How to use a plain abdominal radiograph in children with functional defecation disorders. Archives of disease in childhood - Education & practice edition, 2016. 101(4): p. 187.

    Article  CAS  Google Scholar 

  14. Bosch, M., et al., Systematic assessment of constipation on plain abdominal radiographs in children. Pediatric Radiology, 2006. 36(3): p. 224-226.

    Article  Google Scholar 

  15. Cowlam, S., et al., Blinded comparison of faecal loading on plain radiography versus radio-opaque marker transit studies in the assessment of constipation. Clinical Radiology, 2008. 63(12): p. 1326-1331.

    Article  CAS  Google Scholar 

  16. Harari, D. and K.L. Minaker, Megacolon in patients with chronic spinal cord injury. Spinal Cord, 2000. 38(6): p. 331.

    Article  CAS  Google Scholar 

  17. De Looze, D., et al., Constipation and other chronic gastrointestinal problems in spinal cord injury patients. Spinal Cord, 1998. 36(1): p. 63.

    Article  Google Scholar 

  18. Clark, K., et al., A pragmatic comparative study of palliative care clinician's reports of the degree of shadowing visible on plain abdominal radiographs. Support Care Cancer, 2018. 26(11): p. 3749-3754.

    Article  Google Scholar 

  19. Berger, M.Y., et al., Value of Abdominal Radiography, Colonic Transit Time, and Rectal Ultrasound Scanning in the Diagnosis of Idiopathic Constipation in Children: A Systematic Review. The Journal of Pediatrics, 2012. 161(1): p. 44-50.e2.

    Article  Google Scholar 

  20. Clark, K. and D.C. Currow, Plain Abdominal Radiographs to Diagnose Constipation Patients with Advanced Progressive Illness? Journal of Pain and Symptom Management, 2011. 41(4): p. e2-e3.

    Article  Google Scholar 

  21. Pensabene, L., et al., Lack of utility of abdominal x-rays in the evaluation of children with constipation: comparison of different scoring methods. J Pediatr Gastroenterol Nutr, 2010. 51(2): p. 155-9.

    Article  Google Scholar 

  22. van den Bosch, M., et al., Systematic assessment of constipation on plain abdominal radiographs in children. Pediatr Radiol, 2006. 36(3): p. 224-6.

    Article  Google Scholar 

  23. Blethyn, A.J., et al., Radiological assessment of constipation. Arch Dis Child, 1995. 73(6): p. 532-3.

    Article  CAS  Google Scholar 

  24. Leech, S.C., K. McHugh, and P.B. Sullivan, Evaluation of a method of assessing faecal loading on plain abdominal radiographs in children. Pediatr Radiol, 1999. 29(4): p. 255-8.

    Article  CAS  Google Scholar 

  25. Starreveld, J.S., et al., The plain abdominal radiograph in the assessment of constipation. Z Gastroenterol, 1990. 28(7): p. 335-8.

    CAS  PubMed  Google Scholar 

  26. Barr, R.G., et al., Chronic and occult stool retention: a clinical tool for its evaluation in school-aged children. Clin Pediatr (Phila), 1979. 18(11): p. 674, 676, 677–9, passim.

  27. Chen, S.-Y., Z. Feng, and X. Yi, A general introduction to adjustment for multiple comparisons. Journal of thoracic disease, 2017. 9(6): p. 1725-1729.

    Article  Google Scholar 

  28. O'Donnell, L.J., J. Virjee, and K.W. Heaton, Detection of pseudodiarrhoea by simple clinical assessment of intestinal transit rate. Bmj, 1990. 300(6722): p. 439-40.

    Article  CAS  Google Scholar 

  29. Librach, S.L., et al., Consensus Recommendations for the Management of Constipation in Patients with Advanced, Progressive Illness. Journal of Pain and Symptom Management, 2010. 40(5): p. 761-773.

    Article  Google Scholar 

  30. Cangemi, D.J., et al., Colonic Stool Burden a Useful Surrogate for Slow Transit Constipation as Determined by a Radiopaque Transit Study. Am J Gastroenterol, 2019. 114(3): p. 519-523.

    Article  Google Scholar 

  31. Burkitt, D.P., A.R. Walker, and N.S. Painter, Effect of dietary fibre on stools and the transit-times, and its role in the causation of disease. Lancet, 1972. 2(7792): p. 1408-12.

    Article  CAS  Google Scholar 

  32. Bendezu, R.A., et al., Colonic content: effect of diet, meals, and defecation. Neurogastroenterol Motil, 2017. 29(2).

  33. Lam, C., et al., Colonic response to laxative ingestion as assessed by MRI differs in constipated irritable bowel syndrome compared to functional constipation. Neurogastroenterol Motil, 2016. 28(6): p. 861-70.

    Article  CAS  Google Scholar 

  34. Boccia, G., et al., Dyspeptic symptoms in children: the result of a constipation-induced cologastric brake? Clin Gastroenterol Hepatol, 2008. 6(5): p. 556-60.

    Article  Google Scholar 

  35. Jiang, X., et al., Prevalence and risk factors for abdominal bloating and visible distention: a population-based study. Gut, 2008. 57(6): p. 756-63.

    Article  CAS  Google Scholar 

  36. Vijayvargiya, P., et al., Novel association of rectal evacuation disorder and rumination syndrome: Diagnosis, comorbidities, and treatment. United European Gastroenterology Journal, 2014. 2(1): p. 38-46.

    Article  Google Scholar 

  37. Park, S.Y., et al., Rectal gas volume: Defining cut-offs for screening for evacuation disorders in patients with constipation. Neurogastroenterol Motil, 2017. 29(7).

  38. Park, S.Y., et al., Rectal Gas Volume Measured by Computerized Tomography Identifies Evacuation Disorders in Patients With Constipation. Clin Gastroenterol Hepatol, 2017. 15(4): p. 543-552.e4.

    Article  Google Scholar 

  39. Altman, D.G. and P. Royston, The cost of dichotomising continuous variables. Bmj, 2006. 332(7549): p. 1080.

    Article  Google Scholar 

  40. Del Priore, G., P. Zandieh, and M.-J. Lee, Treatment of continuous data as categoric variables in obstetrics and gynecology. Obstetrics & Gynecology, 1997. 89(3): p. 351-354.

    Article  Google Scholar 

  41. Naggara, O., et al., Analysis by categorizing or dichotomizing continuous variables is inadvisable: an example from the natural history of unruptured aneurysms. AJNR Am J Neuroradiol, 2011. 32(3): p. 437-40.

    Article  CAS  Google Scholar 

  42. Lee, C.I., et al., Diagnostic CT Scans: Assessment of Patient, Physician, and Radiologist Awareness of Radiation Dose and Possible Risks. Radiology, 2004. 231(2): p. 393-398.

    Article  Google Scholar 

  43. Choung, R.S., et al., A low response rate does not necessarily indicate non-response bias in gastroenterology survey research: a population-based study. Journal of Public Health, 2013. 21(1): p. 87-95.

    Article  Google Scholar 

  44. Stastics Canada. Linguistic Characteristics of Canadians. 2011 [cited 2020 January 7th]; Available from: https://www12.statcan.gc.ca/census-recensement/2011/as-sa/98-314-x/98-314-x2011001-eng.cfm.

  45. Ghoshal, U.C., et al., Development, Translation and Validation of Enhanced Asian Rome III Questionnaires for Diagnosis of Functional Bowel Diseases in Major Asian Languages: A Rome Foundation-Asian Neurogastroenterology and Motility Association Working Team Report. Journal of neurogastroenterology and motility, 2015. 21(1): p. 83-92.

    Article  Google Scholar 

  46. Suares, N.C. and A.C. Ford, Prevalence of, and Risk Factors for, Chronic Idiopathic Constipation in the Community: Systematic Review and Meta-analysis. American Journal of Gastroenterology, 2011. 106(9): p. 1582-1591.

    Article  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada

    D. Ferguson & J. Buckley

  2. Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    D. Ferguson & R. D. Holmes

  3. Department of Gastroenterology, Vancouver General Hospital and University of British Colombia, Vancouver, BC, Canada

    R. Scott, M. Alsahafi, F. Donnellan & D. O. Prichard

  4. Belfast City Hospital, Belfast, UK

    R. Scott

  5. Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

    M. Alsahafi

  6. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, 55905, USA

    D. O. Prichard

Authors
  1. D. Ferguson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. D. Holmes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Scott
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Alsahafi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Buckley
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F. Donnellan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D. O. Prichard
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DF: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Validation, Visualization; Roles/Writing—original draft. DH: Investigation, Formal analysis, Writing—review & editing. RS: Investigation, Writing—review & editing. MA: Investigation, Writing—review & editing. JB: Conceptualization, Methodology, Formal Analysis, Writing—review & editing. FD: Conceptualization, Formal Analysis, Writing—review & editing. DOP: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Validation, Visualization; Roles/Writing—original draft, Supervision.

Corresponding author

Correspondence to D. O. Prichard.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

Ethical approval for this study was granted by the University of British Colombia Research Ethics Board (H14-02754).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 55 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ferguson, D., Holmes, R.D., Scott, R. et al. Colonic stool burden on computed tomography does not correlate with bowel habit: a cross-sectional study. Abdom Radiol 46, 506–516 (2021). https://doi.org/10.1007/s00261-020-02689-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-020-02689-y

Keywords

Search

Navigation