Abstract
Objectives
The term functional gastrointestinal disorders (FGID) describes various aggregations of chronic gastrointestinal (GI) symptoms not explained by identifiable organic pathology; accordingly, their diagnosis rests on symptom-based criteria and a process of exclusion. Evidence is lacking on the appropriate use of abdominal imaging studies (AIS) in FGIDs.
Methods
We investigated the utilisation of AIS (site, modality, diagnostic yield/significance) at a tertiary FGID clinic over an 11-year period.
Results
Of 1,621 patients, 507 (31 %; 67.5 % women, mean age 43.9 ± 17.37 years) referred from primary care had 997 AIS (1.7 per patient): ultrasonography (US) 36.1 %, fluoroscopy (FLS) 28.8 %, computed tomography (CT) 19.6 %, plain radiography (PR) 13.5 %, nuclear medicine (NM) 1 %). Of the 997 AIS, 55.6 % (554/997) were normal. Of the AIS with positive findings, 9.9 % (62/625) were deemed ‘probably significant’ and 14.7 % (92/625) ‘significant’. Of the CT and FLS studies, 12.3 % and 13.6 %, respectively, yielded ‘significant’ abnormalities compared to 2.2 % of the US studies and 2.1 % of the PR studies. CT identified five of seven neoplasms, associated with male sex, increasing age and symptom onset after age 50 years.
Conclusions
This study confirmed low use of AIS in tertiary FGID clinics and a high proportion of normal studies. Barium swallow/meal and CT were more likely to identify ‘probably significant’ or ‘significant’ findings, including neoplasms.
Key Points
• Imaging referral rates from a specialist functional gastrointestinal disorder clinic are low
• Despite this, normal studies are still frequent in those who are imaged
• Ultrasonography was the most frequent investigation, yet yielded significant findings infrequently
• Abdominal radiographs accounted for 13.5 % of investigations yet were normal in 71.8 %
• CT and fluoroscopy were more likely to yield positive findings
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References
Karantanos T, Markoutsaki T, Gazouli M, Anagnou NP, Karamanolis DJ (2010) Current insights into the pathophysiology of Irritable Bowel Syndrome. Gut Pathog 2:3
Quigley EM (2009) Impact of bloating and distention in irritable bowel syndrome: have we wandered too far from the Manning creed? Clin Gastroenterol Hepatol 7:7–8
Cash BD, Schoenfeld P, Chey WD (2002) The utility of diagnostic tests in irritable bowel syndrome patients: a systematic review. Am J Gastroenterol 97:2812–2819
Everhart JE, Renault PF (1991) Irritable bowel syndrome in office-based practice in the United States. Gastroenterology 100:998–1005
Drossman DA, Li Z, Andruzzi E et al (1993) U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci 38:1569–1580
Camilleri M, Chang L (2008) Challenges to the therapeutic pipeline for irritable bowel syndrome: endpoints and regulatory hurdles. Gastroenterology 135:1877–1891
Manning AP, Thompson WG, Heaton KW, Morris AF (1978) Towards positive diagnosis of the irritable bowel. Br Med J 2:653–654
Drossman DA, Richter JE, Talley NJ (1994) The functional gastrointestinal disorders and their diagnosis: a coming of age. In: Drossman DA, Richter JE, Talley NJ (eds) The functional gastrointestinal disorders: diagnosis, pathophysiology and treatment. Degnon Associates, McLean, pp 1–23
Thompson WG, Longstreth FG, Drossman DA et al (1999) Functional bowel disorders and functional abdominal pain. Gut 45:II43–II47
Longstreth GF, Thompson WG, Chey WD et al (2006) Functional bowel disorders. Gastroenterology 130:1480–1491
Whitehead WE, Palsson OS, Thiwan SIM et al (2006) Development and validation of the ROME III diagnostic questionaire. In: Drossman DA, Corazziari E, Delvaux M et al (eds) Rome III: the functional gastrointestinal disorders. Degnon, Durham, pp 835–853
O'Connor OJ, McSweeney SE, McWilliams S et al (2012) Role of radiologic imaging in irritable bowel syndrome: evidence-based review. Radiology 262:485–494
Spiller R (2007) Clinical update: irritable bowel syndrome. Lancet 369:1586–1588
Desmond AN, McWilliams S, Maher MM, Shanahan F, Quigley EM (2012) Radiation exposure from diagnostic imaging among patients with gastrointestinal disorders. Clin Gastroenterol Hepatol 10:259–265
Spiegel BM, Farid M, Esrailian E, Talley J, Chang L (2010) Is irritable bowel syndrome a diagnosis of exclusion? A survey of primary care providers, gastroenterologists, and IBS experts. Am J Gastroenterol 105:848–858
Lanitis S, Zacharioudakis C, Zafeiriadou P et al (2012) Incidental findings in trauma patients during focused assessment with sonography for trauma. Am Surg 78:344–372
Orme NM, Fletcher JG, Siddiki HA et al (2010) Incidental findings in imaging research: evaluating incidence, benefit, and burden. Arch Intern Med 170:1525–1532
Ekeh AP, Walusimbi M, Brigham E, Woods RJ, McCarthy MC (2010) The prevalence of incidental findings on abdominal computed tomography scans of trauma patients. J Emerg Med 38:484–489
Elmi A, Tabatabaeir S, Talab SS, Hedgire SS, Cao K, Harisinghani M (2012) Incidental findings at initial imaging workup of patients with prostate cancer: clinical significance and outcomes. AJR Am J Roentgenol 199:1305–1311
Brandt LJ, Chey WD, Schiller LR et al American College of Gastroenterology Task Force on Irritable Bowel Syndrome (2009) An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol 104:S1–S35
Spiller R, Aziz Q, Creed F et al Clinical Services Committee of The British Society of Gastroenterology (2007) Guidelines on the irritable bowel syndrome: mechanisms and practical management. Gut 56:1770–1798
O'Neill SB, McLaughlin PD, Crush L et al (2013) A prospective feasibility study of sub-millisievert abdominopelvic CT using iterative reconstruction in Crohn’s disease. Eur Radiol 23:2503–2512
Acknowledgements
The scientific guarantor of this publication is Professor Michael M. Maher. The authors declare no relationships with any companies whose products or services may have been related to the subject matter of the article. The authors state that this work did not receive any funding. No complex statistical methods were necessary for this study. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational, performed at one institution.
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Breen, M., Murphy, K.P., O’Neill, S.B. et al. The utilisation and diagnostic yield of radiological imaging in a specialist functional GI disorder clinic: an 11-year retrospective study. Eur Radiol 24, 3097–3104 (2014). https://doi.org/10.1007/s00330-014-3315-6
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DOI: https://doi.org/10.1007/s00330-014-3315-6