The purpose of this study was to investigate the potential of a computerized auscultation method for providing an objective, quantitative measure characteristic of irritable bowel syndrome. Bowel sounds from irritable bowel patients and normal controls were digitized using an electronic stethoscope. Computerized analysis indicated that the character of the bowel sounds did not differ significantly between groups. However, the fasting sound-to-sound interval was significantly different between groups (1931 +/- 365 msec for normals and 452 +/- 35 msec for the irritable bowel group; P = 0.0001). Using the sound-to-sound interval as a test for irritable bowel syndrome, the cutoff value of 640 msec resulted in a sensitivity of 89%, and a specificity of 100%. We conclude that computerized analysis of bowel sounds has the potential to be a noninvasive, quantitative, and objective test providing positive criteria in the diagnosis of irritable bowel syndrome.

Crohn's disease is often initially misdiagnosed as irritable bowel syndrome. The goal of this research was to determine if computerized auscultation (fasting enterotachogram analysis) could have a role in distinguishing between these diagnoses. Patients with irritable bowel syndrome, Crohn's disease, and a control group were enrolled in the study. The fasting sound-to-sound interval, standard deviation of the interval, sounds per minute, and percentage time involved with bowel sounds was determined by computerized enterotachogram analysis. The mean sound-to-sound interval for the Crohn's group (1232 msecs) and the controls (1706 msecs) was significantly higher than the irritable bowel group (511 msecs, P < 0.0001). We conclude that Crohn's is not characterized by a shortened interval. The high negative predictive value of the fasting enterotachogram for irritable bowel syndrome suggests that an interval greater than 740 msecs should trigger a search for an alternative diagnosis to irritable bowel. Crohn's disease should be included in that differential.

Computerized auscultation of the abdomen provides a noninvasive and quantitative method to investigate gastrointestinal function. Two-dimensional mapping of bowel sound sites of origin, to the surface of the abdomen, was accomplished through simultaneous recording with three electronic stethoscopes. Control, irritable bowel syndrome, and nonulcer dyspepsia groups were studied. The predominant site of fasting sound production was the right lower quadrant in all except a subgroup of nonucler dyspepsia patients. The second most common site mapped to the area of the stomach. The region mapping to the small intestine was largely devoid of sound. The control group had a higher percentage of sounds in the 184- to 248-Hz range than the functional bowel patients (P < 0.001) for sounds mapping to the stomach region. We conclude that two-dimensional mapping may have the potential to allow for the meaningful and objective categorization of groups of functional bowel patients.

For patients whose duodenal ulcers heal after severe hemorrhage, long-term maintenance therapy with ranitidine is safe and reduces the risk of recurrent bleeding.

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