医療従事者における直腸出血の有病歴. 初期評価と10年間のフォローアップ
M Helfand1, K I Marton, M J Zimmer-Gembeck
1Department of Medicine, Oregon Health Sciences University, Portland 97201-3098, USA.
JAMA
|January 1, 1997
まとめ
目に見える直腸出血は調査を要する. ダブルコントラストバリウムエネマと硬性シグモイドスコーピーを組み合わせたプロトコルは,ポリップ,炎症性腸疾患,結腸がんなどの深刻な状態を正確に診断します.
科学分野:
- 胃腸内科 胃腸内科
- 内科内科は,内科の内科である.
- 診断の精度 診断の精度
背景:
- 目に見える直腸出血は,深刻な病理学的症状を示し得る一般的な症状です.
- この症状を調査する際の診断成果,特にシステムのレビューによって引き出されると,明確にする必要があります.
研究 の 目的:
- システムの見直しを通じて特定された可視直腸出血がさらなる調査を正当化しているかどうかを判断する.
- 直腸出血の評価のための特定の診断プロトコルの正確性を評価する.
主な方法:
- 可視性直腸出血の297人の被験者を対象とした前向きなコホート研究.
- ダブルコントラストバリウムエネマ (DCBE) と硬性シグモイドスコーピーを含むプロトコルが採用されました.
- 長期フォローアップ (10年) を用いて診断を確認した.
主要な成果:
- ポリップ (26),炎症性腸疾患 (9),結腸がん (13) を含む深刻な病理は,患者の24%で診断されました.
- 個別診断検査 (DCBE,シグモイドスコーピー) だけでは十分な感度がありませんでした.
- DCBEと硬性シグモイドスコーピーの組み合わせにより,主要な診断では0.96の感度と0.76の特異性が得られました.
結論:
- 目に見える直腸出血は,システムの見直しによって特定された場合でも,しばしば重大な疾患と関連しています.
- 医師は,すべての成人の直腸出血について積極的に調べるべきです.
- 血液出血を報告した患者には,包括的な大腸視覚化が推奨されます.
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