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.
• Abdominal radiographs accounted for 13.5 % of investigations yet were normal in 71.8 %.
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.
• CT and fluoroscopy were more likely to yield positive findings.
- Functional gastrointestinal disorders
- Irritable bowel syndrome
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging