title: History of visible rectal bleeding in a primary care population. Initial assessment and 10-year follow-up.
abstract: OBJECTIVE
  To determine whether a complaint of visible rectal bleeding that is elicited by a screening review of systems merits investigation and to assess the accuracy of a defined protocol to evaluate bleeding.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Primary care clinics in a veterans medical center.
  
  
  METHODS
  We used an 8-item review of systems to identify 297 individuals with visible rectal bleeding; 201 (68%) of these individuals completed a specified protocol consisting of double-contrast barium enema (DCBE) examination, rigid sigmoidoscopy, and follow-up visit after 6 to 12 months. Ten years later we verified the diagnosis in 131 (93%) of 141 patients whose initial evaluation suggested no cause, or a benign anorectal cause, of bleeding.
  
  
  METHODS
  Final diagnoses after 2 and 10 years; sensitivity and specificity of symptoms, DCBE, and rigid sigmoidoscopy.
  
  
  RESULTS
  We diagnosed serious disease in 48 (24%) of the 201 patients; 26 had polyps, 9 had inflammatory bowel disease, and 13 (6.5%) had colon cancer. Symptoms did not predict the diagnosis. Neither DCBE nor rigid sigmoidoscopy alone was sufficiently sensitive to be used alone, but the combination of DCBE and rigid sigmoidoscopy had a sensitivity of 0.96 and a specificity of 0.76 for the diagnosis of polyps, cancer, or inflammatory bowel disease.
  
  
  CONCLUSIONS
  Self-reported rectal bleeding detected by means of a review of systems was associated with a high likelihood of important pathology. Physicians should ask all adults about visible rectal bleeding and should visualize the entire colon in those who report bleeding.
authors.affiliation: Department of Medicine, Oregon Health Sciences University, Portland 97201-3098, USA.
authors.forename: M
authors.initials: M
authors.lastname: Helfand
authors.forename: K I
authors.initials: KI
authors.lastname: Marton
authors.forename: M J
authors.initials: MJ
authors.lastname: Zimmer-Gembeck
authors.forename: H C
authors.initials: HC
authors.lastname: Sox
mesh_terms: D000328:Adult; D000368:Aged; D001466:Barium Sulfate; D003108:Colonic Diseases / Q000175:diagnosis*; D003110:Colonic Neoplasms / Q000175:diagnosis; D003111:Colonic Polyps / Q000175:diagnosis; D004733:Enema; D005194:Family Practice; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012007:Rectum; D012680:Sensitivity and Specificity; D012812:Sigmoidoscopy
chemical_list: D001466:Barium Sulfate