Diagnostic Utility of Colonoscopy in Evaluation of Dyspepsia and Chronic Abdominal Pain Without the Alarming Signs and Symptoms, and Negative Upper Endoscopy and Cross-sectional Abdominal Imaging

Abstract

Purpose: The appropriateness of colonoscopy in the evaluation of chronic (>3 months) abdominal pain, with negative abdominal and pelvic cross-sectional imaging and without obstructive symptoms, weight loss, diarrhea, gastrointestinal bleeding and unexplained anemia is debatable. Despite the associated procedure risk and cost, colonoscopy is not uncommon for chronic abdominal pain evaluation as strict guidelines do not exist. The aim of our study is to assess the utility of colonoscopy in patients with functional bowel disorders without the alarming signs and symptoms, and negative cross-sectional abdominal imaging including for vascular etiologies and negative upper endoscopy with small bowel biopsies. Methods: We reviewed our endoscopy database for colonoscopies performed with chronic abdominal pain and dyspepsia as indicators. Only chronic abdominal cases meeting the following criteria were included: upper endoscopy with small bowel biopsies and abdominal cross-sectional imaging (CT or MRI with contrast) negative including vascular problems, duration >3 months, no weight loss, no gastrointestinal bleeding in any form or unexplained anemia, no obstructive symptoms or diarrhea. Charts were reviewed for colonoscopy findings. Results: At our institution, a total of approximately 2400 colonoscopies were performed during June and November 2009. Careful review of these procedures yielded 69 cases satisfying the criteria. Results are in the enclosed table. Conclusion: Although diagnostic colonoscopy may be useful in differentiating between organic and functional disorders, our study results question its appropriateness in functional cases without alarming symptoms. This also includes the patients above the age of 50 yrs. Ultimately, colonoscopy for functional bowel disorders such as dyspepsia and chronic abdominal pain in the setting of negative cross-sectional abdominal imaging and upper endoscopy, provides little added benefit, while still carrying an increased procedure related risk and cost. Hence, discretion is necessary.Table