title: Diagnostic work-up of rectal bleeding in general practice.
abstract: BACKGROUND
  GPs have many patients with gastrointestinal discomfort. Among bowel-related complaints, the sign of rectal bleeding is of particular importance in patients aged 50 years and above, as it can be an early sign for serious bowel diseases such as colon carcinoma. Despite many guidelines offered to GPs for screening and early detection of colorectal carcinomas, there is very little information about the actual diagnostic approach to the sign of rectal bleeding.
  
  
  OBJECTIVE
  The aim of the study was to collect data concerning treatment strategies used by GPs who treat patients presenting with rectal bleeding.
  
  
  METHODS
  Prospective data collection.
  
  
  METHODS
  General practices in Germany.
  
  
  METHODS
  Over the course of a year, GPs recorded their treatment strategies in patients presenting with rectal bleeding and associated symptoms. Using a digital practice patient file, physicians participating in the study were able to continuously transmit data electronically to the researchers of the study about diagnostics, referrals, hospital admissions, and final diagnoses.
  
  
  RESULTS
  During the course of 1 year, 94 participating physicians collected data on 1584 patients. Information about treating rectal bleeding was recorded for 422 patients; 60% of the patients were referred to specialists in internal medicine or gastroenterologists for further diagnostics. A colonoscopy was the most frequently performed diagnostic procedure (46.2%). Twenty-two per cent (n = 93) of the patients--54 of them aged 50 years and above--were exclusively treated by their GP without conducting a colonoscopy or cooperating with specialists. For these patients, GPs diagnosed less severe diseases like haemorrhoids or other proctologic diseases.
  
  
  CONCLUSIONS
  By using a study that allows GPs to transmit electronically their findings and data, it is possible to draw a picture of treatment strategies of GPs in patients presenting with rectal bleeding. The high percentage of patients who received medical treatment in consultation with specialists underscores the significance of the sign of rectal bleeding in general practice. The need for further diagnostic measures in patients who have been treated exclusively by GPs has to be discussed.
authors.affiliation: Institute of General Medicine, Berlin, Germany. christoph.heintze@charite.de
authors.forename: Christoph
authors.initials: C
authors.lastname: Heintze
authors.forename: Dorothea
authors.initials: D
authors.lastname: Matysiak-Klose
authors.forename: Thorsten
authors.initials: T
authors.lastname: Kröhn
authors.forename: Ute
authors.initials: U
authors.lastname: Wolf
authors.forename: Alexander
authors.initials: A
authors.lastname: Brand
authors.forename: Christoph
authors.initials: C
authors.lastname: Meisner
authors.forename: Imma
authors.initials: I
authors.lastname: Fischer
authors.forename: Hartwig
authors.initials: H
authors.lastname: Wehrmeyer
authors.forename: Vittoria
authors.initials: V
authors.lastname: Braun
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D005194:Family Practice; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012007:Rectum