Value of a negative colonoscopy in patients with non-specific gastrointestinal symptoms

The yield of colonoscopy for neoplasia among patients aged <50 years with non-specific gastrointestinal symptoms is very low. However, a negative colonoscopy may benefit these patients by decreasing anxiety and thereby reducing subsequent health resource utilization. This study sought to characterize the effect of a negative colonoscopy in terms of: (i) reassurance value; and (ii) decreasing health resource utilization, in patients under 50 years of age with non-specific gastrointestinal symptoms (abdominal pain, diarrhea, constipation).

Consecutive patients, aged 18-49 years, undergoing their first colonoscopy for evaluation of non-specific gastrointestinal symptoms (abdominal pain, diarrhea, constipation) were prospectively enrolled. Health-related anxiety was evaluated before and immediately after disclosure of the negative result of colonoscopy using a validated questionnaire and at 1-, 2- and 6-month intervals postcolonoscopy by telephone follow-up. Symptom scores and health resource utilization were assessed prior to colonoscopy and at 2 and 6 months postcolonoscopy.

Fifty-nine patients were prospectively enrolled. Mean health anxiety score declined immediately after colonoscopy from 20.6 to 17.8. Sustained improvement was seen in anxiety scores at 1, 2 and 6 months. Symptom scores also decreased at 6 months for abdominal pain (2.3 to 1.5), diarrhea (2.3 to 1.6) and constipation (1.9 to 1.6). There was a significant decrease in all four measures of health resource utilization at 6 months postcolonoscopy.

Despite minimal diagnostic yield, colonoscopy for non-specific gastrointestinal symptoms in patients <50 years of age is associated with a decline in health-related anxiety and symptom scores. These effects appear to translate into reductions in health resource utilization.