Does routine abdominal ultrasound enhance diagnostic accuracy in irritable bowel syndrome?

The current recommendation that irritable bowel syndrome (IBS) should be diagnosed positively using minimum investigation raises the possibility that some disorders, particularly gynecological, may be overlooked. Transabdominal ultrasound is now sufficiently sophisticated to allow assessment of all abdominal viscera for associated pathology, and this study was designed to evaluate its role in the diagnosis of IBS.

An ultrasound scan was performed in 125 patients (100 females, 25 males) for whom a confident diagnosis of IBS had been made.

No serious intra-abdominal pathology was encountered, but 20% of females and 8% of males had an ultrasound abnormality. None of these abnormalities resulted in any additional therapeutic measures. A hepatobiliary abnormality was found in similar proportions of males and females (10 vs 8%). Gallstones were most common (5 vs 4%), but in no individual were they considered to entirely account for the presenting symptoms. Eight percent of the women were found to have a pelvic abnormality, but it was not regarded as serious in any of them.

This study confirms that a positive approach to diagnosing IBS is a safe policy. Furthermore, routine ultrasound scanning in IBS is unnecessary and could be counter-productive by detecting many minor abnormalities, which can pose further therapeutic dilemmas.