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Lookup NU author(s): Emeritus Professor Greg RubinORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© British Journal of General Practice.Background: Incidences of colorectal cancer (CRC) and inflammatory bowel disease (IBD) are increasing in those aged <50 years. Aim: To identify and quantify clinical features in primary care of CRC/IBD in those aged <50 years. This study considered the two conditions together and aimed to determine which younger patients, presenting in primary care with symptoms, would benefit from investigation for potentially serious colorectal disease. Design and setting: Matched case-control study using primary care records from the Clinical Practice Research Datalink, UK. Method: Incident cases (aged <50 years) of CRC (n = 1661) and IBD (n = 9578) diagnosed between 2000 and 2013 were each matched with up to three controls (n = 3979 CRC; n = 22 947 IBD). Odds ratios (OR) and positive predictive values (PPV) were estimated for features of CRC/IBD in the year before diagnosis. Results: Ten features were independently associated with CRC/IBD (all P<0.001): rectal bleeding, change in bowel habit, diarrhoea, raised inflammatory markers, thrombocytosis, abdominal pain, low mean cell volume (MCV), low haemoglobin, raised white cell count, and raised hepatic enzymes. PPVs were >3% for rectal bleeding with diarrhoea, thrombocytosis, low MCV, low haemoglobin or raised inflammatory markers; for change in bowel habit with low MCV, thrombocytosis or low haemoglobin; and for diarrhoea with thrombocytosis. Conclusion: This study quantified the risk of serious bowel disease in symptomatic patients aged <50 years in primary care. Rectal bleeding and change in bowel habit are strongly predictive of CRC/IBD when combined with abnormal haematology. The present findings help prioritise patients for colonoscopy where the diagnosis is not immediately apparent.
Author(s): Stapley SA, Rubin GP, Alsina D, Shephard EA, Rutter MD, Hamilton WT
Publication type: Article
Publication status: Published
Journal: British Journal of General Practice
Year: 2017
Volume: 67
Issue: 658
Pages: e336-e344
Print publication date: 01/05/2017
Online publication date: 27/04/2017
Acceptance date: 29/11/2016
Date deposited: 01/09/2017
ISSN (print): 0960-1643
Publisher: Royal College of General Practitioners
URL: https://doi.org/10.3399/bjgp17X690425
DOI: 10.3399/bjgp17X690425
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