Diagnostic yield of colorectal neoplasia with colonoscopy for abdominal pain, change in bowel habits, and rectal bleeding.

OBJECTIVES

To assess the clinical yield of colonoscoping in patients who present with rectal bleeding, persistent abdominal pain, or change in bowel habits in the absence of bleeding.

DESIGN

A prospective study of colonoscopy patients.

SETTING

Three colonoscopy practices in New York City between April 1986 and November 1989.

PATIENTS

Eight hundred sixty-one patients with rectal bleeding, 113 patients with abdominal pain, 154 with change in bowel habits, and 44 patients with both abdominal pain and bowel change.

MAIN RESULTS

Of 861 patients with rectal bleeding, 293 (33.6%) had colonic neoplasia (8.6% cancer and 25% adenomatous polyps). In patients who had colonoscopy because of abdominal pain (n = 113), change in bowel habits (n = 154), or both abdominal pain and bowel change (n = 44), respectively 25 (22.1%), 42 (27.3%), and 10 (22.7%) had colonic neoplasms. If one looks at significant neoplasia (cancer or adenomas > 1 cm), then the findings in rectal bleeders were 14.5%, whereas the abdominal pain, change in bowel habits, and both groups had 7.1%, 7.1%, and 13.6%, respectively. Patients with rectal bleeding were more likely to have multiple adenomas than those with nonbleeding symptoms (p < 0.05).

CONCLUSIONS

Patients with persistent nonbleeding GI symptoms, including abdominal pain and change in bowel habits, have almost as high a yield of colorectal neoplasia as those with rectal bleeding.