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Use of X-ray to Assess Fecal Loading in Patients with Gastrointestinal Symptoms

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Abstract

Background/Aims

There is currently no gold standard for evaluating stool burden in the colon for patients with gastrointestinal symptoms. We aim to examine the relationship between fecal loading on single view abdominal X-ray imaging and gastrointestinal symptoms such as constipation, diarrhea, bloating, and accidental bowel leakage in adult outpatients.

Methods

This retrospective, cross-sectional study examined patients seen at University of Michigan from 2005 to 2017. Chart review of demographic information, reported gastrointestinal symptoms, past medical history, and abdominal radiographic imaging was performed. Bivariate analysis was performed to assess associations between these characteristics and fecal loading. Factors independently associated with fecal loading were identified using logistic regression. Significance was established at p < 0.05.

Results

In total, 319 patients who had an X-ray were included in the final analysis, with 84.0% demonstrating fecal loading on the initial X-ray and most reporting constipation as a symptom (n = 214, 84.3%, p = 0.0334). In logistic regression, a chief complaint of constipation had higher odds of being associated with fecal loading on X-ray compared to diarrhea (adjusted OR 6.41; CI 1.51–27.24, p = 0.0118). Bloating as a reported symptom was statistically significant with an adjusted OR of 2.56 (CI 1.10–5.96, p = 0.0286).

Conclusions

Constipation (as a chief complaint) and bloating (as a symptom) were associated with fecal loading on X-ray imaging, while accidental bowel leakage and diarrhea were not.

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Author notes

  1. Anne Sammarco

    Present address: Department of Obstetrics and Gynecology, Rush University Medical Center, 1725 W. Harrison St., Ste 1138, Chicago, IL, 60612, USA

  2. Mitchell B. Berger

    Present address: Main Line HealthCare Urogynecology Associates, Riddle Hospital, Health Center 3, 1098 W. Baltimore Pike, Ste. 3404, Media, PA, 19063, USA

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA

    Versha Pleasant, Anne Sammarco, Sarah Bell & Mitchell B. Berger

  2. University of Michigan Medical School, 1301 Catherine St., Ann Arbor, MI, 48109, USA

    Grace Keeney-Bonthrone

  3. Department of Internal Medicine, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109, USA

    Richard Saad

Authors
  1. Versha Pleasant
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  2. Anne Sammarco
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Correspondence to Versha Pleasant.

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The authors declare that they have no conflict of interest.

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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. For this type of study, formal consent is not required.

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Pleasant, V., Sammarco, A., Keeney-Bonthrone, G. et al. Use of X-ray to Assess Fecal Loading in Patients with Gastrointestinal Symptoms. Dig Dis Sci 64, 3589–3595 (2019). https://doi.org/10.1007/s10620-019-05770-9

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  • DOI: https://doi.org/10.1007/s10620-019-05770-9

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