Fecal Burden on CT Weakly Correlates with Bowel Function in Adults and is Poorly Associated with Clinical Symptoms.

INTRODUCTION: GI symptoms are frequently non-specific and common across many disorders. Fecal burden on CT imaging is a finding commonly reported on, but with an undefined relationship to GI symptoms. A study was performed to assess the association between fecal burden and GI function and symptoms. METHODS: A single-center cross-sectional study was performed assessing the relationship between fecal burden using the Starreveld scoring method for patients undergoing CT Abdomen/Pelvis for any indication, and GI function and symptoms using a survey tool with a validated GI symptom scale. RESULTS: 205 patients completed surveys on the day of CT exam. Interobserver reliability for fecal burden assessment yielded kappa of 0.6. Spearman correlation showed a negative correlation between total colon fecal burden and stool frequency (rho =  - .21, p = .002), liquid bowel movements (rho =  - .23, p < .001), and bloating (rho =  - .16, p = .02). Positive correlation was identified with difficult stool evacuation (rho = .18; p = .009). No correlation was found for symptoms of hard stools, urgency, fullness, satiety, abdominal discomfort, abdominal pain, or nausea. Logistic regression analysis demonstrated total colon fecal burden distinguished symptom frequency for symptoms of difficulty evacuating (OR 1.12, p = .05) and liquid bowel movements (OR 0.8, p < .001) only. CONCLUSION: Fecal burden on CT imaging is weakly associated with metrics of bowel function and poorly associated with GI symptoms other than difficulty evacuating. This study challenges the practice of attributing GI symptoms to fecal burden beyond those for which there is any identified association.