What Is the Role of Imaging and Reimaging in Patients with Chronic Abdominal Pain?

  • Theodore Katz
  • Janet Smereck


A frequent clinical question when caring for patients with chronic abdominal pain is when to obtain imaging or repeat imaging. Little consensus guidance exists on this issue. As a significant proportion of patients presenting with chronic abdominal pain have functional syndromes rather than underlying organic disease, providers must be judicious with imaging decisions. The choice of imaging modality should be tailored to assessing for a particular diagnosis, rather than as a screening tool. “Red-flag” symptoms can be useful in raising suspicion for underlying organic disease, but may not always necessitate immediate imaging in the emergency department (ED). More studies are needed, but limited evidence appears to indicate that repeating abdominal CT-imaging after previous negative scans has a relatively low yield.


Chronic abdominal pain Computed tomography Imaging Red-flag symptoms Functional abdominal pain 


  1. 1.
    American College of Radiology Appropriateness Criteria. 2017. Available at:
  2. 2.
    Wallander MA, Johansson S, Ruigomez A, Garcia Rodriguez LA. Unspecified abdominal pain in primary care: the role of gastrointestinal morbidity. Int J Clin Pract. 2007;61:1663–70.CrossRefGoogle Scholar
  3. 3.
    Drossman DA, Li Z, Andruzzi E, Temple RD, Talley NJ, Thompson WG, et al. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci. 1993;38:1569–80.CrossRefGoogle Scholar
  4. 4.
    Jones R, Lydeard S. Irritable bowel syndrome in the general population. BMJ. 1992;304:87–90.CrossRefGoogle Scholar
  5. 5.
    Tolba R, Shroll J, Kanu A, Rizk MK. The epidemiology of chronic abdominal pain. In: Kapural L, editor. Chronic abdominal pain. New York: Springer; 2015. p. 13–24.Google Scholar
  6. 6.
    O’Conor O, McSweeney S, McWilliams S, O’Neill S, Shanahan F, Quigley EM, et al. Role of radiological imaging in irritable bowel syndrome: evidence-based review. Radiology. 2012;262:485–94.CrossRefGoogle Scholar
  7. 7.
    Mendelson R. Imaging for chronic abdominal pain in adults. Aust Prescr. 2015;38:49–52.CrossRefGoogle Scholar
  8. 8.
    Brandt L, Chey W, Foxx-Orenstein A, Schiller LR, Schoenfeld PS, Spiegel BM, et al. An evidence-based position statement on the management of irritable bowel syndrome. AJG. 2009;104:S1–S35.PubMedGoogle Scholar
  9. 9.
    Tack J, Talley N, Camilleri M, Holtmann G, Malagelada JR, Stanghellini Y. Functional gastroduodenal disorders. Gastroenterol. 2006;130:1466–79.CrossRefGoogle Scholar
  10. 10.
    Jones R, Charlton J, Latinovic R, Gulliford M. Alarm symptoms and identification of non-cancer diagnoses in primary care: cohort study. BMJ. 2009;339:b3094.CrossRefGoogle Scholar
  11. 11.
    Whitehead WE, Palsson OS, Feld AD, Levy RL, Von Korff M, Turner MJ, et al. Utility of red flag symptom exclusions in the diagnosis of irritable bowel syndrome. AP&T. 2006;24:137–46.Google Scholar
  12. 12.
    Nojkov B, Duffy MC, Cappell MS. Utility of repeated abdominal CT scans after prior negative CT scans in patients presenting to ER with nontraumatic abdominal pain. Dig Dis Sci. 2013;58:1074–83.CrossRefGoogle Scholar
  13. 13.
    Schifeling C, Williams D. Appropriate use of imaging for acute abdominal pain. JAMA Int Med. 2017;177(12):1853.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Theodore Katz
    • 1
  • Janet Smereck
    • 1
  1. 1.Department of Emergency MedicineMedStar Georgetown University HospitalWashington, DCUSA

Personalised recommendations