Lower gastrointestinal symptoms and symptoms-based triaging systems are poor predictors of clinical significant disease on colonoscopy

IntroductionLower gastrointestinal symptoms (LGS) are a common cause of referral to the gastroenterology service. International guidelines are available to prioritise referrals. Some studies have reported that symptoms alone are a poor marker of clinically significant disease (CSD) but symptoms rema...

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Published in:BMJ open gastroenterology 2020-03, Vol.7 (1), p.e000221-e000221
Main Authors: Ismail, Mohd Syafiq, Aoko, Olufemi, Sihag, Sandeep, Connolly, Eimear, Omorogbe, Joseph, Semenov, Serhiy, O'Morain, Neil, O'Connor, Anthony, Breslin, Niall, Ryan, Barbara, McNamara, Deirdre
Format: Article
Language:English
Subjects:
Abdomen
Anemia
Biomarkers
Clinical medicine
colonic diseases
Colonoscopy
Colorectal cancer
Constipation
Diarrhea
Endoscopy
Gastroenterology
IBD
Inflammation
Inflammatory bowel disease
Pain
Patients
Studies
Tumors
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Summary:IntroductionLower gastrointestinal symptoms (LGS) are a common cause of referral to the gastroenterology service. International guidelines are available to prioritise referrals. Some studies have reported that symptoms alone are a poor marker of clinically significant disease (CSD) but symptoms remain the main way to prioritise referrals in routine clinical practice.Aims/backgroundTo correlate LGS with colonoscopy findings in an unselected patient cohort and to investigate whether using National Institute for Health and Care Excellence (NICE) guidelines improve risk stratification.MethodColonoscopy data over a 2-year period were obtained from our endoscopy database. Only patients with assessment of symptoms as their primary indication for colonoscopy were included. Patient records were retrospectively reviewed. Exclusion criteria: known inflammatory bowel disease (IBD), familial cancer syndromes, polyp and colorectal cancer (CRC) surveillance, and prior colonoscopy within 5 years. Demographics, symptoms and colonoscopy findings were recorded and analysed.Results1116 cases were reviewed; 493 (44%) males, age 54.3 years (16–91). CSD occurred in only 162 (14.5%); CRC 19 (1.7%), high-risk adenoma 40 (3.6%), inflammation 97 (8.7%) (IBD 65 (5.8%), microscopic colitis 9 (0.8%) and indeterminate-inflammation 23 (2%)), angiodysplasia 6 (0.5%). Diarrhoea gave the highest diagnostic yield for CSD of 5.3% (OR 3.15, 95% CI 2.2 to 4.7, p
ISSN:2054-4774
2054-4774
DOI:10.1136/bmjgast-2018-000221