HISTORY OF VISIBLE RECTAL BLEEDING IN A PRIMARY-CARE POPULATION - INITIAL ASSESSMENT AND 10-YEAR FOLLOW-UP

Objective.-To determine whether a complaint of visible rectal bleeding that is elicited by a screening review of systems merits investigatio n and to assess the accuracy of a defined protocol to evaluate bleedin g, Design.-Prospective cohort study. Setting.-Primary care clinics in a veterans medical center. Patients.-We used an 8-item review of syste ms to identify 297 individuals with visible rectal bleeding; 201 (68%) of these individuals completed a specified protocol consisting of dou ble-contrast barium enema (DCBE) examination, rigid sigmoidoscopy, and follow-up visit after 6 to 12 months. Ten years later we ve rifled th e diagnosis in 131 (93%) of 141 patients whose initial evaluation sugg ested no cause, or a benign anorectal cause, of bleeding. Main Outcome Measures.-Final diagnoses after 2 and 10 years; sensitivity and speci ficity of symptoms, DCBE, and rigid sigmoidoscopy. Results.-We diagnos ed serious disease in 48 (24%) of the 201 patients; 26 had polyps, 9 h ad inflammatory bowel disease, and 13 (6.5%) had colon cancer. Symptom s did not predict the diagnosis. Neither DCBE nor rigid sigmoidoscopy atone was sufficiently sensitive to be used alone, but the combination of DCBE and rigid sigmoidoscopy had a sensitivity of 0.96 and a speci ficity of 0.76 for the diagnosis of polyps, cancer, or inflammatory bo wel disease. Conclusions.-Self-reported rectal bleeding detected by me ans of a review of systems was associated with a high likelihood of im portant pathology. Physicians should ask all adults about visible rect al bleeding and should visualize the entire colon in those who report bleeding.