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Factors identifying higher risk rectal bleeding in general practice.

Brian G Ellis1, Michael R Thompson

  • 1The Swan Surgery, Petersfield.

The British Journal of General Practice : the Journal of the Royal College of General Practitioners
|December 28, 2005
PubMed
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Rectal bleeding rarely indicates cancer, with over 96% of cases being benign. Specific symptom combinations, like change in bowel habit, increase cancer risk, guiding general practitioner (GP) management.

Area of Science:

  • Gastroenterology
  • Primary Care Medicine
  • Oncology

Background:

  • Rectal bleeding is a common symptom presenting a diagnostic challenge in general practice.
  • Distinguishing serious pathology from self-limiting conditions is crucial for effective patient management.

Purpose of the Study:

  • To identify factors influencing the predictive and diagnostic accuracy of rectal bleeding for bowel cancer in primary care settings.
  • To enhance the diagnostic value of rectal bleeding assessment in general practice.

Main Methods:

  • A one-year prospective observational study involving 319 patients over 34 years old presenting with rectal bleeding.
  • Data collection included flexible sigmoidoscopy, questionnaires, and 18-month follow-up.
  • Outcome measures focused on consultation rates, prevalence of cancer, colitis, polyps, and diagnostic value of symptom combinations.

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Main Results:

  • The annual consultation rate for rectal bleeding in patients over 34 was 15 per 1000.
  • Colorectal cancer prevalence was 3.4%, rising to 9.2% with a change in bowel habit and 11.1% without perianal symptoms.
  • A palpable rectal mass was found in 36% of cancer patients.

Conclusions:

  • Over 96% of patients presenting with rectal bleeding to GPs do not have cancer.
  • Recognizing diagnostic value of symptom combinations can refine GP management strategies.
  • Differentiating high-risk from low-risk patients is essential for appropriate care pathways.