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Antecedentes de sangrado rectal visible en una población de atención primaria. Evaluación inicial y seguimiento de 10

M Helfand¹, K I Marton, M J Zimmer-Gembeck

¹Department of Medicine, Oregon Health Sciences University, Portland 97201-3098, USA.

|January 1, 1997

Resumen

El sangrado rectal visible requiere una investigación. Un protocolo que combina un enema de bario de doble contraste y una sigmoidoscopia rígida diagnostica con precisión afecciones graves como pólipos, enfermedad inflamatoria intestinal y cáncer de colon.

Área de la Ciencia:

Gastroenterología y Gastroenterología.
Medicina interna es la medicina interna de las enfermedades.
Precisión en el diagnóstico.

Sus antecedentes:

El sangrado rectal visible es un síntoma común que puede indicar una patología subyacente grave.
El rendimiento diagnóstico de la investigación de este síntoma, particularmente cuando se obtiene a través de una revisión de los sistemas, requiere una aclaración.

Objetivo del estudio:

Para determinar si el sangrado rectal visible identificado a través de una revisión de los sistemas justifica una investigación adicional.
Para evaluar la precisión de un protocolo de diagnóstico específico para evaluar el sangrado rectal.

Principales métodos:

Estudio de cohorte prospectivo en el que participaron 297 personas con sangrado rectal visible.
Se empleó un protocolo que incluía un enema de bario de doble contraste (DCBE) y sigmoidoscopia rígida.
El seguimiento a largo plazo (10 años) se utilizó para verificar los diagnósticos.

Principales resultados:

La patología grave, incluyendo pólipos (26), enfermedad inflamatoria intestinal (9) y cáncer de colon (13), fue diagnosticada en el 24% de los pacientes.
Las pruebas de diagnóstico individuales (DCBE, sigmoidoscopia) carecían de suficiente sensibilidad por sí solas.
La combinación de DCBE y sigmoidoscopia rígida logró una sensibilidad de 0,96 y una especificidad de 0,76 para diagnósticos importantes.

Conclusiones:

El sangrado rectal visible, incluso cuando se identifica a través de una revisión de los sistemas, con frecuencia se asocia con enfermedades significativas.
Los médicos deben preguntar activamente sobre el sangrado rectal en todos los adultos.
Se recomienda una visualización integral del colon para los pacientes que informan sangrado.

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