Colonic neoplasia in patients with nonspecific GI symptoms.
BACKGROUND
The purpose of this study was to determine the prevalence rate of colonic polyps or masses 1 cm or greater in diameter in patients with nonspecific abdominal symptoms, from diverse practice settings, using a national endoscopic database.


METHODS
Consecutive patients undergoing colonoscopy were included based on procedure indication. Endoscopic data were generated with a computer database at each practice site, transmitted to a central data bank and merged with data from multiple sites for analysis. Group 1 patients had nonspecific abdominal symptoms, which were defined as pain, constipation and diarrhea. Group 2 patients had a positive fecal occult blood test. Group 3 patients were asymptomatic, undergoing screening colonoscopy. Serious colon pathology was defined as a polyp or mass greater than 9 mm in size.


RESULTS
Data were collected from 31 practice sites in 21 states during a period of 18 months. Of the 20,745 colonoscopy examinations, 9.2% were performed to evaluate patients with nonspecific abdominal symptoms, excluding other indications. Among patients with nonspecific symptoms 7.27% had polyp(s) 1 cm or greater in diameter compared with 17.05% of patients with positive fecal occult blood test (odds ratio 2.12: CI [1.73, 2.60]; p < 0.001). Patients with nonspecific symptoms had similar rates of large polyps as asymptomatic patients (7.27% vs. 6.45%, p = 0.32). Multivariate analysis identified several independent variables including increasing age, male gender and practice site at a Veterans Affairs Medical Center.


CONCLUSIONS
In diverse, practice-based settings, patients with nonspecific abdominal symptoms who are referred for colonoscopy do not have a higher risk of serious colonic pathology than asymptomatic patients.
Lieberman
D A
DA
Departments of Medicine, Oregon Health Sciences University, Portland 97207, USA.
de Garmo
P L
PL
Fleischer
D E
DE
Eisen
G M
GM
Chan
B K
BK
Helfand
M
M
D015746:Abdominal Pain / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D003110:Colonic Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D003248:Constipation / Q000175:diagnosis*; D016208:Databases, Factual; D003967:Diarrhea / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007417:Intestinal Polyps / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence