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Am Fam Physician. 2022;105(3):322

Clinical Question

Which patients with vague abdominal symptoms should be referred for further workup?

Bottom Line

Using a cutoff of 3% risk (from The National Institute for Health and Care Excellence), dysphagia or changes in bowel habits in men and rectal bleeding in women should trigger referral for further workup to exclude cancer or inflammatory bowel disease (IBD). Symptoms such as abdominal pain, changes in bowel habits, or dyspepsia in patients older than 60 years should be investigated because they predict cancer or IBD in more than 3% of men and women. (Level of Evidence = 1b)

Synopsis

The authors worked with routinely collected electronic health record data of 1.9 million patients from 742 general practices in the United Kingdom collected between the years 2000 and 2017. They included data of all patients who had at least one visit for a vague abdominal symptom and looked to see whether that patient was given a diagnosis of cancer or IBD in the subsequent year. For patients with two or more symptoms, one symptom was chosen randomly as the primary symptom. The median age ranged from 54 to 63 years at first consultation. Changes in bowel habits in men were associated with a cancer diagnosis in 4.64% of cases and an IBD diagnosis in 2.82% of cases. Dysphagia in men was associated with cancer in 4.28% of cases, mainly esophageal cancer. In women, rectal bleeding was the greatest predictor: 2.39% for cancer and 2.57% for IBD. Dyspepsia was the symptom least likely to be associated with cancer or IBD. Abdominal bloating/distension and abdominal pain were associated with cancer or IBD less than 2% of the time. In patients 60 years or older, abdominal pain, changes in bowel habits, and dyspepsia predicted cancer or IBD in more than 3% of men and women.

Study design: Descriptive

Funding source: Government

Setting: Population-based

Reference: Herbert A, Rafiq M, Pham TM, et al. Predictive values for different cancers and inflammatory bowel disease of 6 common abdominal symptoms among more than 1.9 million primary care patients in the UK: a cohort study. PLoS Med. 2021;18(8):e1003708.

Editor’s Note: Dr. Shaughnessy is an assistant medical editor for AFP.

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POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

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A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

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