Irritable Bowel Syndrome (Suspected)

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Irritable Bowel Syndrome (IBS)

• IBS is a chronic condition characterized by intermittent abdominal pain associated with bowel dysfunction
• The pooled prevalence of IBS is noted to be around 7% in the adult population 1

Imaging in Irritable Bowel Syndrome

• A recent systematic review on the role of imaging in IBS concluded that though radiologic imaging is frequently used in the evaluation of patients suspected with IBS, there is a striking lack of strong evidence to support their routine use. The authors concluded that based on the current evidence, further investigations including radiologic imaging should only be done in patients who have alarm symptoms to rule out other structural abnormalities which may mimic IBS. They found that early referral to a physician experienced in IBS is more beneficial than embarking on imaging for structural abnormalities. Similar to the ACG Task Force on IBS, authors of this systematic review suggest no further imaging for patients suspected with IBS symptoms but have no alarm features 4
• Among patients with alarm features, three different groups are identified 4
  • Patients with RUQ & biliary features in whom abdominal ultrasound should be the initial investigation
  • Patients with diarrhoea-predominant IBS or mixed (diarrhoea and constipation) IBS in whom colonoscopy should be the first line of investigation
  • Patients with constipation-predominant IBS in whom further investigations are based on their risk of having a colorectal cancer. High risk patients should have colonoscopy while medium and low risk can undergo CT colonography if available, otherwise double contrast barium enema

References

References

References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document

1. American College of Gastroenterology Task Force on Irritable Bowel Syndrome, Brandt LJ, Chey WD, Foxx-Orenstein AE, Schiller LR, Schoenfeld PS, Spiegel BM, Talley NJ, Quigley EM. An evidence-based position statement on the management of irritable bowel syndrome. Am J Gastroenterol. 2009;104 Suppl 1:S1-35. (Level I evidence)
2. Vanner SJ, Depew WT, Paterson WG, DaCosta LR, Groll AG, Simon JB, Djurfeldt M. Predictive value of the Rome criteria for diagnosing the irritable bowel syndrome. Am J Gastroenterol. 1999;94(10):2912-7. (Level III evidence)
3. Manning AP, Thompson WG, Heaton KW, Morris AF. Towards positive diagnosis of the irritable bowel. Br Med J. 1978;2(6138):653-4. (Level III evidence)
4. O'Connor OJ, McSweeney SE, McWilliams S, O'Neill S, Shanahan F, Quigley EM, Maher MM. Role of radiologic imaging in irritable bowel syndrome: evidence-based review. Radiology. 2012;262(2):485-94. (Level I evidence)
5. Ralls DW, Colletti PM, Lapin SA, et al. Real time sonography in suspected acute cholecystitis. Prospective evaluation of primary and secondary signs. Radiology. 1985; 155:767-71. (Level II evidence)
6. Yarmentitis SD. Ultrasound of the gallbladder and the biliary tree. Eur Radiol. 2002;12:270-82. (Review article)
7. Soyer P, Brouland JP, Boudiaf M, et al. Colour velocity imaging and power Doppler sonography of the gallbladder wall: a new look at the sonographic diagnosis of acute cholecystitis. AJR Am J Roentgenol. 1998;171:183-8. (Level II/III evidence)
8. Amouyal P, Palazzo L, Amouyal G, et al. Endosonography: promising method for diagnosis of extrahepatic cholestasis. Lancet. 1989;18:1195-8. (Level II/III evidence)
9. Dancygier GH, Natermann C. The role of endoscopic ultrasonography in the biliary tract diseases: obstructive jaundice. Endoscopy. 1994;26:800-2. (Level II/III evidence)
10. Halligan S, Altman DG, Taylor SA, et al. CT colonography in the detection of colorectal polyps and cancer: systematic review, meta-analysis, and propsed minimum data set for study level reporting. Radiology. 2005;237:893-904. (Level II evidence)
11. Mulhall BP, Veerappan GR, Jackson JL. Meta-analysis: computed tomographic colonography. Ann Int Med. 2005;142:635-50. (Level III evidence)
12. Taylor SA, Halligan S, Slater A, et al. Comparison of radiologists' confidence in excluding significant colorectal neoplasia with multidetector-row CT colonography compared with double contrast barium enema. Br J Radiol. 2006;79:208-15. (Level II evidence)
13. Rockey DC, Paulsen EK, Niedzwiecki D, et al. Analysis of air contrast barium enema, computed tomographic colonography, and colonoscopy: prospective comparison. Lancet. 2005;365:305-11. (Level III evidence)
14. Pickhardt PJ. Incidence of colonic perforation at CT colonography: review of existing data and implications for screening of asymptomatic adults. Radiology. 2006;239:313-6. (Review article)
15. Sosna J, Blachar A, Amitai M, et al. Colonic perforation at CT colonography: assessment of risk in a multicenter large cohort. Radiology. 2006;239:457-63. (Level II evidence)
16. Burling D, Halligan S, Slater A, et al. Potentially serious adverse events at CT colonography in symptomatic patients: national survey of the United Kingdom. Radiology. 2006;239:464-71. (Level II evidence)
17. Brenner DJ, Georgsson MA. Mass screening with CT colonography: should the radiation exposure be of concern? Gastroenterology. 2005; 129:328-37. (Level IV evidence)
18. ASGE Standards of Practice Committee, Shen B, Khan K, Ikenberry SO, Anderson MA, Banerjee S, Baron T, Ben-Menachem T, Cash BD, Fanelli RD, Fisher L, Fukami N, Gan SI,Harrison ME, Jagannath S, Lee Krinsky M, Levy M, Maple JT, Lichtenstein D, Stewart L, Strohmeyer L, Dominitz JA. The role of endoscopy in the management of patients with diarrhea. Gastrointest Endosc. 2010;71(6):887-92. (Practice guidelines)
19. Korman LY, Overholt BF, Box T, Winker CK. Perforation during colonoscopy in endoscopic ambulatory surgical centers. Gastrointest Endosc. 2003;58(4):554-7. (Level II evidence)

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