The utilisation and diagnostic yield of radiological imaging in a specialist functional GI disorder clinic: an 11-year retrospective study

Micheal Breen; Kevin P. Murphy; Siobhan B. O’Neill; Joanne P. O’Donovan; Sebastian McWilliams; Alan N. Desmond; Fergus Shanahan; Eamonn M. Quigley; Michael M. Maher

doi:10.1007/s00330-014-3315-6

The utilisation and diagnostic yield of radiological imaging in a specialist functional GI disorder clinic: an 11-year retrospective study

Micheal Breen
, Kevin P. Murphy
, Siobhan B. O’Neill
, Joanne P. O’Donovan
, Sebastian McWilliams
, Alan N. Desmond
, Fergus Shanahan
, Eamonn M. Quigley
, Michael M. Maher

School of Medicine

University College Cork

Research output: Contribution to journal › Article › peer-review

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.

• 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.

Original language	English
Pages (from-to)	3097-3104
Number of pages	8
Journal	European Radiology
Volume	24
Issue number	12
DOIs	https://doi.org/10.1007/s00330-014-3315-6
Publication status	Published - 14 Nov 2014

Keywords

Functional gastrointestinal disorders
Imaging
Irritable bowel syndrome
Radiology
Ultrasonography

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10.1007/s00330-014-3315-6

Cite this

@article{93495233efa544a487ac13fd876d0450,

title = "The utilisation and diagnostic yield of radiological imaging in a specialist functional GI disorder clinic: an 11-year retrospective study",

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 {\textquoteleft}probably significant{\textquoteright} and 14.7 \% (92/625) {\textquoteleft}significant{\textquoteright}. Of the CT and FLS studies, 12.3 \% and 13.6 \%, respectively, yielded {\textquoteleft}significant{\textquoteright} 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 {\textquoteleft}probably significant{\textquoteright} or {\textquoteleft}significant{\textquoteright} 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.",

keywords = "Functional gastrointestinal disorders, Imaging, Irritable bowel syndrome, Radiology, Ultrasonography",

author = "Micheal Breen and Murphy, \{Kevin P.\} and O{\textquoteright}Neill, \{Siobhan B.\} and O{\textquoteright}Donovan, \{Joanne P.\} and Sebastian McWilliams and Desmond, \{Alan N.\} and Fergus Shanahan and Quigley, \{Eamonn M.\} and Maher, \{Michael M.\}",

note = "Publisher Copyright: {\textcopyright} 2014, European Society of Radiology.",

year = "2014",

month = nov,

day = "14",

doi = "10.1007/s00330-014-3315-6",

language = "English",

volume = "24",

pages = "3097--3104",

journal = "European Radiology",

issn = "0938-7994",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "12",

}

TY - JOUR

T1 - The utilisation and diagnostic yield of radiological imaging in a specialist functional GI disorder clinic

T2 - an 11-year retrospective study

AU - Breen, Micheal

AU - Murphy, Kevin P.

AU - O’Neill, Siobhan B.

AU - O’Donovan, Joanne P.

AU - McWilliams, Sebastian

AU - Desmond, Alan N.

AU - Shanahan, Fergus

AU - Quigley, Eamonn M.

AU - Maher, Michael M.

PY - 2014/11/14

Y1 - 2014/11/14

N2 - 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.

AB - 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.

KW - Functional gastrointestinal disorders

KW - Imaging

KW - Irritable bowel syndrome

KW - Radiology

KW - Ultrasonography

UR - https://www.scopus.com/pages/publications/84911806669

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DO - 10.1007/s00330-014-3315-6

M3 - Article

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AN - SCOPUS:84911806669

SN - 0938-7994

VL - 24

SP - 3097

EP - 3104

JO - European Radiology

JF - European Radiology

IS - 12

ER -

The utilisation and diagnostic yield of radiological imaging in a specialist functional GI disorder clinic: an 11-year retrospective study

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Keywords

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