BIG MEETING - BRITISH and IRISH Gastroenterology

1st Oral Prize BIG 2017

Alaa Alakkari
Adelaide and Meath Hospital, and Trinity College, Dublin.

Oral (17BIG239)

Lower Gastrointestinal Symptoms In Young Patients: Can Symptoms And Non-invasive Tests Be Used Systematically To Avoid Unnecessary Colonoscopies?

Author(s)

A.Alakkari, M. Hussey, B.M. Ryan.

Department(s)/Institutions

Department of Gastroenterology, and Clinical Medicine, Adelaide and Meath Hospital, and Trinity College, Dublin.

Introduction

Colonoscopies in young patients presenting with lower GI symptoms are often normal. Avoidance of colonoscopy in such instances reduces patient risk exposure and rationalises limited resource utilisation.

Aims/Background

To assess colonoscopy outcome, relevant faecal and blood tests in young symptomatic patients.

Method

Colonoscopies performed over 1 year were retrospectively identified from the ERS. Patient charts, faecal calprotectin (FC) and CRP were reviewed. A raised CRP or FC of ≥ 50 ug/g was considered abnormal. Inclusion and exclusion criteria are in table 1.

 

Results

242/ 2155 medical GI outpatient colonoscopies performed over 12 months met inclusion criteria for the study. Median age 34 years (range 16-45), 141 (58%) female. Indications; (Group A) diarrhoea 132/242 (55%), (Group B) constipation, abdominal pain/ bloating 110/242 (45%). Colonoscopy was normal in 104 (79%) of Group A and 102 (93%) of Group B (p = 0.002). 28/36 (78%) patients with mucosal inflammation confirmed on histology had diarrhoea (p = 0.0001). FC was available in 36 patients, and CRP in 171. In group A the NPV, sensitivity and specificity of CRP / FC were 88%, 42% and 86%. In group B these figures were 95%, 38% and 95%. 21 patients had incidental early adenomatous polyps.

Conclusions

Colonoscopy has very low yield in young symptomatic patients, especially those with non–diarrhoeal symptoms. Non-invasive tests should be used systematically to better identify patients requiring colonoscopy. We are conducting a prospective study to explore non-invasive diagnostic paradigms. Implementation of these strategies will help reduce colonoscopy waiting times.