Feature Article

Chronic abdominal pain in adults: when is imaging indicated?

Richard Mendelson



Diagnostic imaging is often not indicated in patients with chronic abdominal pain. If imaging is required, the most appropriate modality will depend on the symptoms present and the individual clinical scenario. Both the referrer and the imaging specialist should ensure all procedures are justified, with potential benefits outweighing the risks.

Key Points

  • Diagnostic imaging is often not indicated in people with chronic abdominal pain, and most patients with functional causes can be diagnosed without the need for any diagnostic imaging.
  • CT scans are overused in patients with undifferentiated chronic abdominal pain.
  • The most frequent cause of chronic abdominal pain is irritable bowel syndrome.
  • Certain symptom patterns can be identified that will indicate the optimal method of investigation.
  • Alarm symptoms, including anaemia, blood in the stool, waking at night with gastrointestinal symptoms and weight loss, should be investigated. The most appropriate modality depends on the symptoms.
  • A normal ‘conventional’ CT scan does not rule out cancer.
  • Clinical information on the request forms for CT scans should be specific and include the suspected condition because this helps the radiologist to determine an appropriate imaging protocol and assists in the interpretation of the findings.

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