Colonic stool burden on computed tomography does not correlate with bowel habit: a cross-sectional study

Area of Science:

• Radiology
• Gastroenterology
• Clinical Medicine

Background:

• Abdominal radiographs have limitations in assessing stool burden due to variable fecal shadowing and inter-rater reliability.
• Computed tomography (CT) is hypothesized to overcome these limitations in evaluating constipation.
• Physician reliance on imaging for bowel function assessment warrants investigation.

Purpose of the Study:

• To determine if stool burden on CT correlates with bowel movement frequency, stool form, or functional constipation diagnosis.
• To investigate physician utilization of CT scans in assessing patients' bowel function.

Main Methods:

• Patients undergoing non-emergent abdominal CT completed a bowel questionnaire.
• Stool burden was quantified from CT images, with inter-rater reliability assessed in a subgroup.
• Physicians' use of abdominal imaging for bowel habit assessment was surveyed online.

Main Results:

• No significant associations were found between CT-identified fecal burden and stool form, bowel frequency, symptoms, or constipation diagnosis.
• Physician surveys indicated opportunistic use of imaging data; 18% requested CT for chronic bowel habit assessment.
• Approximately 30% of physicians believed current evidence supported using CT for this purpose.

Conclusions:

• Objective assessment indicates that colonic stool burden on CT does not correlate with patient-reported constipation symptoms or diagnosis.
• Despite physician use of CT for assessing chronic bowel habits, current objective data does not support this practice.
• Further research may be needed to clarify the role of imaging in functional bowel disorder assessment.