Factors associated with the frequency of stool examination: effect on incidence of reported rectal bleeding.

BACKGROUND: Rectal bleeding is an important presenting symptom of colorectal cancer. The presentation and investigation of patients with rectal bleeding may be delayed if people do not regularly inspect their stool or toilet paper. AIM: To determine how frequently stool or toilet paper is inspected, factors associated with the frequency of inspection, and whether this affects the reported prevalence of rectal bleeding. METHODS: A questionnaire on the frequency of stool inspection and the occurrence of various gastrointestinal symptoms and diseases was developed, validated and sent to 2149 subjects chosen from four general practice lists in south-west London. RESULTS: There was a 79% response rate. Four hundred and forty-two of 1611 subjects (27%) examined both their stool and toilet paper every time. One hundred and two (6%) never examined either. Those who always examined their stool and toilet paper were more likely to report rectal bleeding compared to those who never examined either (23% vs 4%). They were also more likely to be male, to open their bowels more than three times per day, to have watery stools, to experience urgency, and have a history of piles. CONCLUSION: Many people examine their stools and toilet paper infrequently. The possibility that this may contribute to delayed diagnosis of colorectal cancer deserves further evaluation.

A new, highly sensitive assay for C-reactive protein can aid the differentiation of inflammatory bowel disorders from constipation- and diarrhoea-predominant functional bowel disorders.

BACKGROUND: Patients presenting to gastroenterology clinics with symptoms suggestive of lower-bowel disorders often require extensive investigation to differentiate functional from organic disease. C-reactive protein (CRP) is a sensitive marker of systemic inflammation. Levels of CRP are frequently raised in cases of inflammatory bowel disease (IBD). However, using conventional assays, not all cases of IBD have a detectable level. OBJECTIVE: To determine whether a new highly sensitive CRP enzyme-linked immunosorbent assay (ELISA) can aid the differentiation between IBD and functional bowel disorders (FBDs) in gastroenterology outpatients presenting with lower-bowel symptoms. METHODS: Serum was taken from 224 subjects attending a gastroenterology outpatient clinic. Of these, 203 were new patients and 21 were follow-up patients with quiescent colitis. The serum was analysed using a sensitive in-house ELISA. All new patients had a rigid sigmoidoscopy and rectal biopsy. Patients were investigated as deemed appropriate by the attending physician. Notes were reviewed after at least 6 months to determine the final diagnosis. RESULTS: A cut-off value of 2.3 mg/l had a sensitivity of 100% and a specificity of 67% in differentiating FBD from new cases of IBD. The geometric mean CRP was 0.383 mg/l in the constipation-predominant FBD group, 1.435 mg/l in diarrhoea-predominant FBD, 1.455 mg/l in quiescent IBD, 8.892 mg/l in newly presenting cases of ulcerative colitis, and 13.123 mg/l in newly presenting cases of Crohn's disease. CONCLUSION: A new, highly sensitive assay for CRP may help to distinguish FBD from IBD.