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Clinical features of bowel disease in patients aged <50 years in primary care: a large case-control study

Sally A Stapley1, Greg P Rubin2, Deborah Alsina3

  • 1University of Exeter Medical School, Exeter.

The British Journal of General Practice : the Journal of the Royal College of General Practitioners
|March 29, 2017
PubMed

Insights

Younger patients with rectal bleeding or change in bowel habit, especially with abnormal blood tests, have a higher risk of colorectal cancer (CRC) and inflammatory bowel disease (IBD). These findings aid in prioritizing investigations for serious bowel conditions.

Area of Science:

  • Gastroenterology
  • Oncology
  • Primary Care Medicine

Background:

  • Increasing incidence of colorectal cancer (CRC) and inflammatory bowel disease (IBD) in individuals under 50 years old.
  • Need for better identification of younger patients with potential serious colorectal disease presenting in primary care.

Purpose of the Study:

  • To identify and quantify clinical features in primary care for CRC and IBD in patients under 50.
  • To determine which symptomatic younger patients warrant investigation for serious colorectal disease.

Main Methods:

  • Matched case-control study utilizing UK primary care records (Clinical Practice Research Datalink).
  • Analysis of incident cases of CRC (n=1661) and IBD (n=9578) aged <50 diagnosed 2000-2013, matched with controls.
  • Estimation of odds ratios (OR) and positive predictive values (PPV) for clinical features in the year preceding diagnosis.

Main Results:

  • Ten features independently associated with CRC/IBD (P<0.001): rectal bleeding, change in bowel habit, diarrhea, raised inflammatory markers, thrombocytosis, abdominal pain, low MCV, low hemoglobin, raised white cell count, and raised hepatic enzymes.
  • High PPVs (>3%) observed for combinations of symptoms (e.g., rectal bleeding with diarrhea) and abnormal hematology (e.g., thrombocytosis, low MCV, low hemoglobin).

Conclusions:

  • Quantified risk of serious bowel disease in symptomatic patients under 50 in primary care.
  • Rectal bleeding and change in bowel habit, combined with abnormal hematology, are strong predictors of CRC/IBD.
  • Findings assist in prioritizing colonoscopy for patients where diagnosis is not immediately clear.
Abstract

Keywords:
colorectal neoplasmsdiagnosisgeneral practiceinflammatory bowel diseasessigns and symptoms

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