Tessler Robert, Gupta Shailvi, Pathak John, Ghimire Pranita, Kingham Thomas P, Kushner Adam L, Amatya Kapendra Shekhar, Nwomeh Benedict C
Department of Surgery, University of California San Francisco East Bay, Oakland, California.
Department of Surgery, University of California San Francisco East Bay, Surgeons OverSeas, Oakland, California.
J Surg Res. 2015 Jul;197(1):12-7.e1. doi: 10.1016/j.jss.2015.02.048. Epub 2015 Feb 28.
Because rectal bleeding is a cardinal symptom of many colorectal diseases including colorectal cancers, its presence alone could give insight into the prevalence of these conditions where direct population screening is lacking. In South Asia, which is home to over one fifth of the world's population, there is paucity of epidemiologic data on colorectal diseases, particularly in the lower-income countries such as Nepal. The aim of this study was to enumerate the prevalence of rectal bleeding in Nepal and increase understanding of colorectal diseases as a health problem in the South Asian region.
A countrywide survey using the Surgeons OverSeas Assessment of Surgical Need tool was administered from May 25-June 12, 2014 in 15 of the 75 districts of Nepal, randomly selected proportional to population. In each district, three Village Development Committees were selected randomly, two rural and one urban based on the Demographic Health Survey methodology. Individuals were interviewed to determine the period and point prevalence of rectal bleeding and patterns of health-seeking behavior related to surgical care for this problem. Individuals aged >18 y were included in this analysis.
A total of 1350 households and 2695 individuals were surveyed with a 97% response rate. Thirty-eight individuals (55% male) of the 1941 individuals ≥ 18 y stated they had experienced rectal bleeding (2.0%, 95% confidence interval 1.4%-2.7%), with a mean age of 45.5 (standard deviation 2.2). Of these 38 individuals, 30 stated they currently experience rectal bleeding. Health Care was sought in 18 participants with current rectal bleeding, with two major procedures performed, one an operation for an anal fistula. For those who sought health care but did not receive surgical care, reasons included no need (4), not available (6), fear and/or no trust (5), and no money for health care (1). For those with current rectal bleeding who did not seek health care, reasons included no need (1), not available (2), fear and/or no trust (6), and no money for health care (3). Twenty-three individuals had an unmet surgical need secondary to rectal bleeding (1.2%, 95% confidence interval 0.8%-1.8%).
The Nepal health care system at present does not emphasize the importance of surveillance colonoscopies or initial diagnostics by a primary care physician for rectal bleeding. Our data demonstrate limited access for patients to undergo evaluation of rectal bleeding by a health care professional and that potentially there are people in Nepal with rectal bleeding that may have undiagnosed colorectal cancer. Further advocacy for preventative medicine and easier access to surgical care in lower-income countries is crucial to avoid emergency surgeries, advanced stage malignancies, or fatalities from treatable conditions.
由于直肠出血是包括结直肠癌在内的许多结直肠疾病的主要症状，在缺乏直接人群筛查的情况下，仅其存在就可以深入了解这些疾病的患病率。南亚地区拥有世界五分之一以上的人口，但缺乏关于结直肠疾病的流行病学数据，尤其是在尼泊尔等低收入国家。本研究的目的是统计尼泊尔直肠出血的患病率，并增进对南亚地区作为一个健康问题的结直肠疾病的了解。
2014年5月25日至6月12日，在尼泊尔75个区中的15个区进行了一项全国性调查，采用海外外科医生手术需求评估工具，按人口比例随机选取。在每个区，根据人口健康调查方法随机选择三个乡村发展委员会，两个农村的和一个城市的。对个体进行访谈，以确定直肠出血的期间患病率和点患病率以及针对该问题寻求手术治疗的就医行为模式。纳入分析的个体年龄均大于18岁。
共调查了1350户家庭和2695名个体，应答率为97%。在1941名年龄≥18岁的个体中，有38人（55%为男性）表示曾经历过直肠出血（2.0%，95%置信区间1.4%-2.7%），平均年龄为45.5岁（标准差2.2）。在这38人中，有30人表示目前正在经历直肠出血。18名目前有直肠出血的参与者寻求了医疗护理，其中进行了两项主要手术，一项是肛瘘手术。对于那些寻求医疗护理但未接受手术治疗的人，原因包括不需要（4人）、无法获得（6人）、恐惧和/或不信任（5人）以及没有钱支付医疗费用（1人）。对于那些有直肠出血但未寻求医疗护理的人，原因包括不需要（1人）、无法获得（2人）、恐惧和/或不信任（6人）以及没有钱支付医疗费用（3人）。23人因直肠出血存在未满足的手术需求（1.2%，95%置信区间0. 8%-1.8%）。
尼泊尔目前的医疗保健系统并不强调监测结肠镜检查或初级保健医生对直肠出血进行初步诊断的重要性。我们的数据表明，患者难以获得医疗保健专业人员对直肠出血的评估，并且在尼泊尔可能存在直肠出血但结直肠癌未被诊断的人群。在低收入国家进一步倡导预防医学并使人们更容易获得手术治疗对于避免急诊手术、晚期恶性肿瘤或可治疗疾病导致的死亡至关重要。
