Diagnostic Imaging Pathways - Irritable Bowel Syndrome (Suspected)

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Population Covered By The Guidance

This pathway provides guidance on imaging in patients with non-specific or undifferentiated chronic abdominal pain who are suspected of having a functional bowel syndrome. ‘Alarm features’ and other indications for investigation are described.

Date reviewed: December 2012

Date of next review: 2017/2018

Published: December 2012

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No radiation None 0
Minimal radiation Minimal < 1 millisieverts
Low radiation Low 1-5 mSv
Medium radiation Medium 5-10 mSv
High radiation High >10 mSv


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Irritable Bowel Syndrome (IBS)

Imaging in Irritable Bowel Syndrome


Diagnosis of Irritable Bowel Syndrome (IBS)


  1. Abdominal Pain relieved by defecation
  2. Looser stools with the onset of pain
  3. More frequent stools with the onset of pain
  4. Abdominal distension
  5. Passage of mucous
  6. Feeling of incomplete defecation (tenesmus)


  1. Altered stool frequency
  2. Altered stool form
  3. Altered stool passage
  4. Passage of mucous
  5. Bloating or distension

Alarm symptoms 1,4

ACG Task Force also stated in their review that the overall accuracy of alarm symptoms although poor, the presence of any should warrant consideration for further investigations 1


Abdominal Ultrasound


Computed Tomography Colonography (CTC) and Double Contrast Barium Enema (DCBE)





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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Information for Consumers

Information from this website

Information from the Royal Australian and New Zealand College of Radiologists’ website

Radiation Risks of X-rays and Scans

Computed Tomography (CT)


Computed Tomography (CT)

Contrast Medium (Gadolinium versus Iodine)

Gadolinium Contrast Medium

Iodine-Containing Contrast Medium

Radiation Risk of Medical Imaging During Pregnancy

Radiation Risk of Medical Imaging for Adults and Children


CT Colonography



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