title: Telephonic management of rectal bleeding in young adults: a prospective randomized controlled trial.
abstract: OBJECTIVE
  The majority of young adults referred with rectal bleeding to a colorectal specialist clinic have a very low risk of serious disease such as cancer, and a high chance of gaining symptom relief by simple dietary changes. To determine whether young low-risk patients with rectal bleeding can be managed with a structured telephonic interview and dietary advice, rather than an outpatient visit.
  
  
  METHODS
  A single-blinded, prospective, randomized controlled trial was performed in two stages. Patients under 40 years with rectal bleeding only were offered inclusion. Part-I trial: Patients were interviewed on telephone by the colorectal nurse specialist (CNS) and randomized to receive dietary advice (Advice Group) or not (Control Group). All patients were seen in clinic 6 weeks later by a doctor 'blinded' to their trial status. Part-II trial: Patients were interviewed on telephone by the CNS and again randomized to an Advice Group or a Control Group. The Control Group were seen in clinic 6 weeks later. The Advice Group were telephoned again 6 weeks later, and if their bleeding had stopped, were not brought to clinic. All patients were tracked for a year after the study to ensure no adverse diagnoses came to light.
  
  
  RESULTS
  Part-I trial: 63 of 89 eligible patients were contactable and none refused the study. Seventy per cent of the Advice Group compared with 33% (P = 0.001) of the Control Group had symptomatic improvement when seen in clinic. Approximately 30% of each group required further treatment. Part-II trial: 54 of 94 eligible patients were contactable. However a further nine declined to enter the trial; 90% of patients in the Advice Group had improved at 6 weeks as judged by telephone interview compared with 56% of patients in the Control Group (P = 0.024) who were seen in clinic. The 90% of patients who improved in the Advice Group did not need to come to clinic to be seen. In both parts of the trial, the CNS identified a small number of patients with urgent symptoms at interview and brought them to clinic. The majority had anal fissures or haemorrhoids although in Part-II, one patient had ulcerative colitis and one had colorectal cancer.
  
  
  CONCLUSIONS
  Telephonic consultation is an effective way of identifying those patients with urgent symptoms among a cohort of young adults referred to the hospital with rectal bleeding. Telephonic dietary advice leads to resolution of rectal bleeding in the majority of patients without urgent symptoms.
authors.affiliation: Department of Colorectal Surgery, Whittington Hospital, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Raje
authors.forename: M
authors.initials: M
authors.lastname: Scott
authors.forename: T
authors.initials: T
authors.lastname: Irvine
authors.forename: M
authors.initials: M
authors.lastname: Walshe
authors.forename: H
authors.initials: H
authors.lastname: Mukhtar
authors.forename: A
authors.initials: A
authors.lastname: Oshowo
authors.forename: C
authors.initials: C
authors.lastname: Ingham Clark
mesh_terms: D000328:Adult; D004032:Diet; D006471:Gastrointestinal Hemorrhage / Q000628:therapy*; D006801:Humans; D007407:Interviews as Topic; D009720:Nurse Clinicians; D011446:Prospective Studies; D012002:Rectal Diseases / Q000601:surgery*; D016037:Single-Blind Method