Indications for colonoscopy make injteresting reading

Hello

Came across this GRS Global advice for colonoscopy. I thought people here may be interested due to symptoms when they think they have serious disease.

Interesting comments in guidelines

'Alternating constipation and diarrhea is rarely a symptom of organic colonic disease' quote. ...I found that interesting

Can I ask, do most doctors label IBS without a colonoscopy. Given the sometimes alrming symptoms that people have with IBS.


**************************************** *************
Hermon Taylor Endoscopy Unit
Royal London Hospital
Barts and The London NHS Trust

12 - 2006

Guidelines for referral for Colonoscopy



Urgent referral (2 weeks or less)
Colonoscopy is the usual investigation for suspected colorectal cancer (CRC). Such patients (1, 2) should be referred urgently to one of the Gastroenterology medical consultants or Colorectal consultants prior to endoscopy.
The current NICE guidelines (2) for urgent referral for investigation of suspected colonic cancer are summarised in the table on the next page. The protocol for investigation of iron deficiency is taken from BSG guidelines (1).
Patients aged less than 40 years with rectal bleeding and a change in bowel habit towards looser stools/and or increased stool frequency do not usually need urgent referral.
Constipation (infrequent passage of hard formed stools) is not an indication for colonoscopy. Alternating constipation and diarrhea is rarely a symptom of organic colonic disease.
A family history of colorectal cancer or inflammatory bowel disease (IBD) or severe symptoms with abnormal baseline blood tests (to suggest IBD) may prompt urgent referral.


Indication for urgent referral for suspected lower gastrointestinal cancer
Sign, symptom or combination Age threshold
A right lower abdominal mass consistent with involvement of the large bowel. All ages
A palpable intraluminal rectal (not pelvic) mass on PR examination. All ages
*Unexplained iron deficiency anaemia:
 In men (Hb < 11 g/dl and non-menstruating women (Hb <10g/dl).
 In pre-menopausal women
 In pre-menopausal women with lower GI symptoms, a strong family history of colorectal cancer (one affected first degree relative < 45 years old, or two affected first degree relatives).
All ages
Over 50 years
Less than 50 years
Rectal bleeding persisting for 6 weeks or more. Over 60 years
Change in bowel habit to looser stools and/or more frequent stools persisting for 6 weeks or more WITHOUT rectal bleeding. Over 60 years
Rectal bleeding WITH a change in bowel habit towards looser stools and/or increased stool frequency persisting 6 weeks or more. 40 years and older
For evaluation of an abnormality on barium enema or other imaging study, which is likely to be clinically significant, such as a filling defect or stricture suggesting malignancy. All ages
Metastatic adenocarcinoma of unknown primary site in the absence of colonic signs or symptoms when colonoscopic findings of a tumour will influence management and choice of chemotherapy.
All ages
*Colonoscopy in these patients should be done in conjunction with an upper GI Endoscopy and distal duodenal biopsies or serology for coeliac disease. BSG Guidelines (1) recommend that celiac serology and urine testing for blood is performed in all patients with iron deficiency.

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Tony, read the thread

Information on diagnosing ibs and help with doctors.

Its on information on diagnosing IBS.

The diagnoses has changed. It use to be a diagnoses of exclusion but that has changed and its diagnosed on a specific cluster of symptoms, minus red flags.

Diagnosis of IBS

http://www.aboutibs.org/site/about-ibs/symptoms/diagnosis

another one

Current Approach to the Diagnosis of
Irritable Bowel Syndrome

Summary
A knowledgeable physician can diagnose IBS by careful
review of the patient’s symptoms, a physical examination,
and selected diagnostic procedures that are often limited to
a few basic tests. Such a diagnosis is quite secure, as
follow-up for many years of confidently diagnosed
patients seldom discloses another cause for their
symptoms. With an unequivocal diagnosis, both patient
and physician can work together on the most effective
management.


http://www.aboutibs.org/store/viewproduct/163


They usually use a colonoscopy to make sure there is not something wrong visually and if there are red flag symptoms.