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

Stapley, Sally A.; Rubin, Greg P.; Alsina, Deborah; Shephard, Elizabeth A.; Rutter, Matthew D.; Hamilton, William T.

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


Authors

Sally A. Stapley

Greg P. Rubin

Deborah Alsina

Elizabeth A. Shephard

Matthew D. Rutter

William T. Hamilton



Abstract

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.

Citation

Stapley, S. A., Rubin, G. P., Alsina, D., Shephard, E. A., Rutter, M. D., & Hamilton, W. T. (2017). Clinical features of bowel disease in patients aged

Journal Article Type Article
Acceptance Date Nov 29, 2016
Online Publication Date Mar 28, 2017
Publication Date May 1, 2017
Deposit Date May 17, 2017
Publicly Available Date Mar 28, 2018
Journal British Journal of General Practice
Print ISSN 0960-1643
Electronic ISSN 1478-5242
Publisher Royal College of General Practitioners
Peer Reviewed Peer Reviewed
Volume 67
Issue 658
Pages e336-e344
DOI https://doi.org/10.3399/bjgp17x690425
Public URL https://durham-repository.worktribe.com/output/1378892