The ‘Natural History’ of Declined Outpatient Gastroenterology Referrals

OBJECTIVE: To evaluate the ‘natural history’ of outpatients who were referred to the Division of Gastroenterology at the University of Alberta Hospital (Edmonton, Alberta) for gastrointestinal problems and were subsequently declined.METHODS: Patients were tracked for 12 months after they were referred and declined for the following indications: abdominal pain, rectal bleeding, fecal occult blood test-positive stools and iron deficiency. For each patient, data regarding consultations by other gastroenterologists or surgeons working in the region, clinically relevant diagnoses and the number of gastrointestinal-related x-rays performed were obtained.RESULTS: Of a total sample size of 230 patients, 110 (47.8%) were seen by another gastroenterologist or surgeon after decline. A significant diagnosis was made in 21 patients (9.1%), which had immediate clinical consequences in 29%. Forty per cent of patients underwent one or more gastointestinal-related x-rays before being declined, which increased to 55% after decline.CONCLUSION: Approximately 50% of declined patients were seen by other gastroenterologists or surgeons in the region. In 9.1% of these patients, a clinically important diagnosis was made, of which one-quarter had immediate medical consequences.

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Association between Charlson-Deyo Score and delay to colonoscopy in veterans subsequently diagnosed with colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.288 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 288-288

Author(s):

Thi Khuc ◽

Christian Jackson

Keyword(s):

Colorectal Cancer ◽

United States ◽

Occult Blood ◽

The United States ◽

Fecal Occult Blood ◽

Study Cohort ◽

Fecal Occult ◽

Final Study ◽

Increased Risk ◽

History Of

288 Background: Colorectal cancer (CRC) is the second most common cause of cancer deaths in the United States and expected to cause 51,020 deaths in 2019. Early detection with yearly fecal occult blood test (FOBT) has been proven to decrease CRC mortality. A 30-day delay from positive FOBT to colonoscopy is associated with increased risk of CRC. The Veterans Affairs Health System (VAHS) treats approximately 11% of CRCs in the United States. The effects of an aging population, physician shortage, and increased military personnel entering the VAHS may increase demands on VAHS resources. The primary aim of this study was to determine risk factors that caused delay to colonoscopy. Methods: We retrospectively reviewed records of 600 patients referred for colonoscopy from January 1999 to January 2009, who were subsequently diagnosed with CRC. Patients with a prior CRC diagnosis were excluded. The final study cohort consisted of 530 patients. We analyzed the relationship between 10 variables and delay in time from initial consultation to colonoscopy. Variables consisted of age, sex, race, ethnicity, CRC location, marital status, history of mental health diagnosis, tobacco use, substance abuse, Charlson/Deyo (C/D) score and season of referral for colonoscopy. A delay in time was defined as 30 days or greater. Logistic regression analysis adjusted for age, race, CRC location and C/D score. Results: A total of 87.17% of patients experienced a delay in time from initial consultation to colonoscopy. When analyzed with a predictive variable of delay to colonoscopy, C/D score of ≥ 2 versus 0, was associated with higher odds of delay in time to colonoscopy (OR = 2.18, p = 0.02). African American race and Hispanic ethnicity was associated with a higher odds of delay in time to colonoscopy, but was not statistically significant (OR = 1.47, p = 0.47, OR = 1.37, p = 0.48). Conclusions: Patients with a C/D score ≥ 2 were 218% more likely to have delay in time from initial consult to colonoscopy, resulting in a delayed CRC diagnosis. C/D score may be used to determine which patients should have more frequent reminders to schedule their colonoscopy to prevent delays in care. Randomized and prospective studies will need to be performed.

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Successful recovery of COVID-19-associated recurrent diarrhea and gastrointestinal hemorrhage using convalescent plasma

Military Medical Research ◽

10.1186/s40779-020-00273-5 ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

Li-Bo Zhang ◽

Rong-Rong Pang ◽

Qing-Hua Qiao ◽

Zhi-Hua Wang ◽

Xin-Yi Xia ◽

...

Keyword(s):

Alternative Therapy ◽

Gastrointestinal Symptoms ◽

Occult Blood ◽

Fecal Occult Blood ◽

Treatment Alternative ◽

Plasma Therapy ◽

Case Presentation ◽

Fecal Occult ◽

Successful Recovery ◽

Gastrointestinal Problems

Abstract Background Gastrointestinal symptoms are not rare among coronavirus disease 2019 (COVID-19) patients, but there have been no reports regarding convalescent plasma therapy for the recovery of gastrointestinal problems in COVID-19 patients. Case presentation We present two cases of patients with COVID-19-associated recurrent diarrhea and positive fecal occult blood who successfully recovered after a one-time convalescent plasma administration. Conclusion When COVID-19 patients develop recurrent or refractory gastrointestinal symptoms and fail to respond to the available treatment, alternative therapy with convalescent plasma administration may be considered.

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Incidental Colorectal Computed Tomography Abnormalities: Would You Send every Patient for a Colonoscopy?

Canadian Journal of Gastroenterology ◽

10.1155/2008/901250 ◽

2008 ◽

Vol 22 (9) ◽

pp. 758-760 ◽

Cited By ~ 7

Author(s):

Edy Stermer ◽

Alexandra Lavy ◽

Tova Rainis ◽

Omer Goldstein ◽

Dean Keren ◽

...

Keyword(s):

Computed Tomography ◽

Diverticular Disease ◽

Occult Blood ◽

Wall Thickening ◽

Fecal Occult Blood ◽

Abdominal Ct ◽

Colorectal Tumour ◽

Fecal Occult ◽

Neoplastic Lesions ◽

History Of

BACKGROUND: The clinical significance of colorectal wall thickening (CRWT) in patients undergoing abdominal computed tomography (CT) has not yet been definitively established.OBJECTIVES: To compare alleged findings on abdominal CT with those of a follow-up colonoscopy.METHODS: Ninety-four consecutive patients found to have large-bowel abnormalities on abdominal CT were referred for colonoscopy. Of these patients, 48 were referred for a suspected colorectal tumour and 46 for CRWT. Colonoscopy was performed and findings were compared.RESULTS: Of the 48 suspected colorectal tumours, 34 were determined to be neoplastic lesions on colonoscopy. Of these, 26 were malignant and eight were benign. Colonoscopy revealed no abnormality in 30 of 46 patients with CRWT as a solitary finding, and revealed some abnormality in 16 patients (12 had diverticular disease, four had benign neoplastic lesions).CONCLUSIONS: CRWT as an incidental and solitary finding on CT should not be regarded as a pathology prompting a colonoscopy. Approximately two-thirds of the patients had a normal colonoscopy and the remaining patients had benign lesions (12 had diverticular disease and four had benign neoplastic lesions). However, many of these patients seem to warrant colonoscopy regardless of CT findings, particularly patients who have a family history of colorectal cancer, have positive fecal occult blood test results or who are older than 50 years of age.

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