These hospitals receive patients from both urban and rural districts of Västra Götaland, a region in southwestern Sweden. We performed a retrospective cohort study on all CRC fast track patients referred over a one-year period to the three endoscopy units at the Sahlgrenska University Hospital and to Kungälv Hospital (from May 2016 to May 2017). without anaemia and/or bleeding, who were under 55 years of age. We hypothesised that there would be a low diagnostic yield for CRC in patients presenting with CIBH only, i.e. With this in mind, we aimed to appraise the Swedish colonoscopy fast track referral system, in particular with regard to the diagnostic yield of CIBH for CRC within different age categories. 19 Moreover, given that IBS commonly affects young to middle-aged adults, the Scandinavian guidelines may lead to such individuals being unnecessarily fast-tracked for a colonoscopy. 16 – 18 The discrepancies between country guidelines may be due to the lack of conclusive evidence for CIBH as an alarm symptom for CRC, as well as the non-specific nature of the symptom indeed, CIBH can also be caused by common functional bowel disorders, such as irritable bowel syndrome (IBS). 15 However, in Sweden, Norway and Denmark, a lower threshold has been chosen with regard to CIBH these Scandinavian countries recommend fast track colonoscopy for CIBH of over 4 weeks in patients over 40 years of age. 13 In the United Kingdom, the National Institute for Health and Care Excellence recommends all patients aged 60 years or older with CIBH to get a prompt colonoscopy. 11, 14 The American College of Gastroenterology does not recommend performing colonoscopies on non-bleeding patients with CIBH. 11 – 13 However, CIBH as a sole trigger for fast track colonoscopy evaluation is disputed: a 2008 meta-analysis and a 2011 systematic review found overall poor positive and negative likelihood ratios for CIBH, with a statistical heterogeneity of results between the included studies. 10 Unexplained visible rectal bleeding and iron deficiency anaemia are well-established CRC alarm features that often lead to prompt referrals for colonoscopy. 9 The most common symptoms and clinical features include weight loss, anaemia, abdominal pain, rectal bleeding and change in bowel habit (CIBH). Presenting features of CRC are often non-specific and vary considerably between individuals. Although screening programmes are highly effective for early diagnosis and prevention, 6, 7 the majority of CRC patients still encounter healthcare services only after symptom manifestation. 4, 5 In an attempt to establish earlier diagnoses, health authorities across Europe have implemented different national screening programmes and symptom-based investigative pathways for CRC. 3 Although 5-year survival rates for CRC are over 90% when diagnosed early, they decrease considerably with cancer stage progression. 2 Overall, CRC has a higher prevalence in men than in women, and the likelihood of developing the condition increases markedly after 50 years of age. Alternating IBS is more frequent in women.Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer death in Europe, 1 with a predicted 98,000 deaths in 2018. Changes in IBS subtypes are common, but changes between constipation and diarrhoea are rare. The frequency of constipation and diarrhoea remains relatively stable over time. This change was associated to female gender (OR: 2.65). Only 14% of cases changed from constipation to diarrhoea or vice versa. Most changes occurred from/to mixed or unsubtyped IBS. A third of patients maintained the same habit throughout the study. Over 50% of the patients had the same bowel habit when each diary was compared with the next one. Frequency of constipation and diarrhoea showed little changes throughout the study. Rome II showed low-moderate agreement (42%) with BSS to define bowel habit. Bristol Stool Scale (BSS) was used to define bowel habit.įour-hundred patients completed the study. Symptoms were recorded daily in diary cards during four 4-week periods along the study. To evaluate the change over time of bowel habit in IBS patients followed-up during 1 year.įive hundred and seventeen patients with IBS were prospectively included in an observational study with five evaluations over a 1-year period. Evolution of bowel habit in irritable bowel syndrome (IBS) is not well known.
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