Review of the role of abdominal imaging in irritable bowel syndrome

Abstract

The role of radiologic imaging in the investigation of irritable bowel syndrome (IBS) remains a subject of debate and there is some evidence, from recent studies of utilization of imaging in IBS, which focused on associated costs and radiation exposure, that imaging is being used relatively widely in these patients. This review aims to assess current best evidence to accurately define the role of radiologic imaging in IBS patients. Primary and secondary literature searches were performed. Evidence suggests that the lack of “red flag” or alarm features in IBS patients should reassure the clinician that the diagnosis of IBS is correct and United States and United Kingdom guidelines recommend no radiologic imaging for IBS patients if alarm features are not present. In patients presenting with IBS symptoms and alarm features, radiologic testing may be used to exclude an alternative diagnosis and the imaging modality should be chosen based on the most likely alternative diagnosis.

Keywords: Abdominal imaging; Rome criteria; Irritable bowel syndrome

Core tip: Radiologic imaging in irritable bowel syndrome (IBS) remains contentious and the evidence guiding its use is limited. Recent studies indicate that imaging is being widely used in these patients. This review assesses current best evidence for the role of imaging in IBS. Primary and secondary literature searches were performed. The cornerstone of diagnosis remains the Rome criteria. Lack of “red flag” features in IBS patients should strengthen diagnosis of IBS and obviate the need for radiologic imaging. If red flag features are present, appropriate imaging may be used to exclude a suspected alternative diagnosis.