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

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.

Publication metadata

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


DOI: 10.3399/bjgp17X690425


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