title: Predictors of persistent gastrointestinal symptoms among new presenters to primary care.
abstract: OBJECTIVE
  To quantify the relative contribution of environmental, clinical, infection and psychosocial factors in the persistence of gastrointestinal (GI) symptoms among new patients presenting to primary care.
  
  
  METHODS
  We conducted a population-based prospective cohort study of 4986 adults aged 25-65 years. The study team obtained permission from the participants to monitor their general practice records for consultation with GI symptoms and to contact them at that time. Group 1 (n = 177) patients completed a postal questionnaire, whereas those in group 2 (n = 191) completed an identical questionnaire and provided a blood and stool sample. The participants were followed up for 1 and 6 months postconsultation.
  
  
  RESULTS
  Of 610 (12.2%) participants who consulted, 368 (60.3%) agreed to participate. Two hundred and eighty participants (76.1%) completed 1 and 6-month follow-up questionnaires and 106 (37.9%) had persistent (present 1 and 6 months postconsultation) GI symptoms. After adjusting for age, sex, area of residence and duration of symptoms before consultation, symptom persistence was independently predicted by high levels of psychological distress [odds ratio (OR): 2.5, 95% confidence interval (CI): (1.1-5.3)], symptom episode duration of more than 2 h [OR: 3.1, 95% CI: (1.3-7.1)] and symptom interference with daily activities [OR: 2.3, 95% CI: (1.1-4.8)]. Changing diet [OR: 0.2, 95% CI: (0.1-0.9)] and recent gastroenteritis or food poisoning [OR: 0.2, 95% CI: (0.1-0.98)] were associated with protective effects. Infection was not associated. Exposure to three or more of these factors identified 87.3% (n = 92) of the participants with persistent symptoms.
  
  
  CONCLUSIONS
  The factors measured at the time of consultation with GI symptoms can accurately predict those patients at increased risk of persistent symptoms up to 6 months later.
authors.affiliation: Gastrointestinal Sciences Research Group, School of Translational Medicine, Clinical Sciences Building, Salford Royal NHS Foundation Trust, Stott Lane, Salford, UK.
authors.forename: Smita
authors.initials: S
authors.lastname: Halder
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Macfarlane
authors.forename: David
authors.initials: D
authors.lastname: Thompson
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: O'Brien
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Musleh
authors.forename: John
authors.initials: J
authors.lastname: McBeth
mesh_terms: D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000097:blood; D001424:Bacterial Infections / Q000150:complications / Q000175:diagnosis; D002908:Chronic Disease; D004777:Environment; D005243:Feces / Q000382:microbiology; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000523:psychology; D016480:Helicobacter pylori / Q000276:immunology; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011159:Population Surveillance; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications / Q000175:diagnosis; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D000907:Antibodies, Bacterial