Advertisement

Rectal bleeding and diminutive colon polyps

  • David Lieberman
    Correspondence
    Address requests for reprints to: David Lieberman, M.D., Chief, Division of Gastroenterology, Oregon Health and Science University, Portland VA Medical Center P3-GI, 1037 SW Veterans Hospital Road, Portland, Oregon 97239 USA; fax: (503) 220-3426
    Affiliations
    Division of Gastroenterology, Oregon Health and Science University, Portland VA Medical Center, Portland, Oregon, USA
    Search for articles by this author
      Visible rectal bleeding is a very common occurrence in the general population. Up to 15% of adults report seeing blood in the toilet bowl or on toilet paper in the previous 6 months.
      • Talley N.J.
      • Jones M.
      Self-reported rectal bleeding in a United States community prevalence, risk factors and health care seeking.
      ,
      • Crosland A.
      • Jones R.
      Rectal bleeding prevalence and consultation behaviour.
      This symptom is considered an important sign of colonic disease, including malignancy. Although relatively few people seek health care to evaluate rectal bleeding,
      • Talley N.J.
      • Jones M.
      Self-reported rectal bleeding in a United States community prevalence, risk factors and health care seeking.
      rectal bleeding is one of the most common indications for colonoscopy in the United States. In an evaluation of practice patterns among 100 diverse practice sites in the United States, visible rectal bleeding was listed as an indication in 22% of all colonoscopy procedures in adults (Clinical Outcomes Research Initiative: CORI; personal communication, January 2004).

      Abbreviations:

      AP (adenomatous), CRC (colorectal cancer), HP (hyperplastic polyps), MSI (microsatellite instability), NNE (number needed to endoscope)
      To read this article in full you will need to make a payment
      AGA Member Login
      Login with your AGA username and password.
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Talley N.J.
        • Jones M.
        Self-reported rectal bleeding in a United States community.
        Am J Gastroenterol. 1998; 93: 2179-2183
        • Crosland A.
        • Jones R.
        Rectal bleeding.
        Br Med J. 1995; 311 (486-468)
        • Goulston K.J.
        • Cook I.
        • Dent O.F.
        How important is rectal bleeding in the diagnosis of bowel cancer and polyps?.
        Lancet. 1986; 2: 261-265
        • Guillem J.G.
        • Forde K.A.
        • Treat M.R.
        • Neugut A.I.
        • Bodian C.A.
        The impact of colonoscopy on the early detection of colonic neoplasms in patients with rectal bleeding.
        Ann Surg. 1987; 206: 606-611
        • Mant A.
        • Bokey E.L.
        • Chapuis P.H.
        • Killingback M.
        • Hughes W.
        • Koorey S.G.
        • Cook I.
        • oulston K.J.
        • Dent O.F.
        Rectal bleeding.
        Dis Colon Rectum. 1989; 32: 191-196
        • Church J.M.
        Analysis of colonoscopic findings in patients with rectal bleeding according to the pattern of their presenting symptoms.
        Dis Colon Rectum. 1991; 34: 391-395
        • Korkis A.M.
        • McDougall C.J.
        Rectal bleeding in a patient less than 50 years of age.
        Dig Dis Sci. 1995; 40: 1520-1523
        • Helfand M.
        • Marton K.I.
        • Zimmer-Gembeck M.J.
        History of visible rectal bleeding in a primary care population.
        JAMA. 1997; 277: 44-48
        • Segal W.N.
        • Greenberg P.D.
        • Rockey D.C.
        • Cello J.P.
        • McQuaid K.R.
        The outpatient evaluation of hematochezia.
        Am J Gastroenterol. 1998; 93: 179-182
        • Fine K.D.
        • Nelson A.C.
        • Ellington T.
        • Mossburg A.
        Comparison of the color of fecal blood with the anatomical location of gastrointestinal bleeding lesions.
        Am J Gastroenterol. 1999; 94: 3202-3210
        • Mulcahy H.E.
        • Patel R.S.
        • Postic G.
        • Eloubeidi M.A.
        • Vaughan J.A.
        • Wallace M.
        • Barkun A.
        • Jowel P.S.
        • Leung J.
        • Libby E.
        • Nickl N.
        • Schutz S.
        • Cotton P.B.
        Yield of colonoscopy in patients with nonacute rectal bleeding.
        Am J Gastroenterol. 2002; 97: 328-333
        • Jemal A.
        • Murray T.
        • Samuels A.
        • Ghafoor A.
        • Ward E.
        • Thun M.J.
        Cancer statistics 2003.
        CA Cancer J Clin. 2003; 53: 5-26
        • Winawer S.J.
        • Stewart E.T.
        • Zauber A.G.
        • Bond J.H.
        • Ansel H.
        • Waye J.D.
        • Hall D.
        • Hamlin A.
        • Schapiro M.
        • O’Brien M.J.
        • Sternberg S.S.
        • Gottlieb L.S.
        • NPS Workgroup
        A comparison of colonoscopy and double-contrast barium enema for surveillance after polypectomy.
        N Engl J Med. 2000; 342: 1766-1772
        • Johnson C.D.
        • Toledan A.Y.
        • Harman B.A.
        • Dachman A.H.
        • McFarland E.G.
        • Barish M.A.
        • Brink J.A.
        • Ernst R.D.
        • Fletcher J.G.
        • Halvosen R.A.
        • Hara A.K.
        • Hopper K.D.
        • Koehler R.E.
        • Lu D.S.K.
        • Macari M.
        • MacCarty R.L.
        • Miller F.H.
        • Morrin M.
        • Paulson E.K.
        • Yee J.
        • Zalis M.
        Computerized tomographic colonography.
        Gastroenterology. 2003; 125: 688-695
        • Pickhardt P.J.
        • Choie R.
        • Hwang I.
        • Butler J.A.
        • Puckett M.L.
        • Hildebrandt H.A.
        • Wong R.K.
        • Nugent P.A.
        • Mysiliwiec P.A.
        • Schindler W.R.
        Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults.
        N Engl J Med. 2003; 349: 2191-2200
        • Johnson C.D.
        • Harmsen W.S.
        • Wilson L.A.
        • MacCarty R.L.
        • Welch T.J.
        • Ilstrup D.M.
        • Ahlquist D.A.
        Prospective blinded evaluation of computed tomographic colonography for screen detection of colorectal polyps.
        Gastroenterology. 2003; 125: 311-319
        • Lieberman D.A.
        • Weiss D.G.
        • Bond J.H.
        • Ahnen D.J.
        • Garewal H.
        • Chejfec G.
        • VACSP Group # 380
        Use of colonoscopy to screen asymptomatic adults for colorectal cancer.
        N Engl J Med. 2000; 343: 162-168
        • Nelson D.B.
        • McQuaid K.R.
        • Bond J.H.
        • Lieberman D.A.
        • et al.
        Procedural success and complications of large-scale screening colonoscopy.
        Gastrointest Endosc. 2002; 55: 307-314
        • Winawer S.
        • Fletcher R.
        • Rex D.
        • Bond J.
        • Burt R.
        • Ferrucci J.
        • Ganiats T.
        • Levin T.
        • Woolf S.
        • Johnson D.
        • Kirk L.
        • Litin S.
        • Simmang C.
        Colorectal cancer screening and surveillance.
        Gastroenterology. 2003; 124: 544-560
        • Imperiale T.F.
        • Wagner D.R.
        • Lin C.Y.
        • Larkin G.R.
        • Rogge J.D.
        • Ransohoff D.F.
        Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings.
        N Engl J Med. 2000; 343: 169-174
        • Weston A.P.
        • Campbell D.R.
        Diminutive colonic polyps.
        Am J Gastroenterol. 1995; 90: 24-28
        • Grandqvist S.
        • Gabrielsson N.
        • Sundelin P.
        Diminutive colonic polyps.
        Endoscopy. 1979; 1: 36-42
        • Tedesco F.J.
        • Hendrix J.C.
        • Pickens C.A.
        • et al.
        Diminutive polyps.
        Gastrointest Endosc. 1982; 28: 1-5
        • Feczko P.J.
        • Bernstein M.A.
        • Halpert R.D.
        • et al.
        Small colonic polyps.
        Radiology. 1984; 152: 301-303
        • Gottlieb L.S.
        • Winawer S.G.
        • Sternberg S.S.
        • et al.
        National Polyp Study (NPS).
        Gastrointest Endosc. 1984; 28: 143
        • Waye J.D.
        • Lewis B.S.
        • Frankel A.
        • Geller S.A.
        Small colon polyps.
        Am J Gastroenterol. 1988; 83: 120-122
        • Matek W.
        • Guggenmoos-Holzmann I.
        • Demling L.
        Follow-up of patients with colorectal adenomas.
        Endoscopy. 1985; 17: 175-181
        • Muto T.
        • Kamiya J.
        • Sawada T.
        • et al.
        Small “flat adenoma” of the large bowel with special reference to its clinicopathologic features.
        Dis Colon Rectum. 1985; 28: 847-851
        • Atkin W.S.
        • Morson B.C.
        • Cuzick J.
        Long-term risk of colorectal cancer after excision of rectosigmoid adenomas.
        N Engl J Med. 1992; 326: 658-662
        • Winawer S.J.
        • Zauber A.G.
        • Ho M.N.
        • O’Brien M.J.
        • Gottlieb L.S.
        • Sternberg S.S.
        • Waye J.D.
        • Schapiro M.
        • Bond J.H.
        • Panish J.F.
        • Ackroyd F.
        • Shike M.
        • Kurtz R.C.
        • Hornsby-Lewis L.
        • Gerdes H.
        • Stewart E.T.
        Prevention of colorectal cancer by colonoscopic polypectomy.
        N Engl J Med. 1993; 329: 1977-1981
        • Imperiale T.F.
        • Wagner D.R.
        • Lin C.Y.
        • Larkin G.N.
        • Rogge J.D.
        • Ransohoff D.F.
        Results of screening colonoscopy among persons 40 to 49 years of age.
        N Engl J Med. 2002; 346: 1781-1785
        • Imperiale T.F.
        • Wagner D.R.
        • Lin C.Y.
        • Larkin G.N.
        • Rogge J.D.
        • Ransohoff D.F.
        Using risk for advanced proximal colonic neoplasia to tailor endoscopic screening for colorectal cancer.
        Ann Intern Med. 2003; 139: 959-965
        • Morson B.C.
        • Bussey H.J.R.
        Magnitude of risk for cancer in patients with colorectal adenomas.
        Br J Surg. 1985; 72: S23-S28
        • Winawer S.J.
        • Zauber A.G.
        • O’Brien M.J.
        • Ho M.N.
        • Gottlieb L.
        • Sternberg S.S.
        • Waye J.D.
        • Bond J.
        • Schapiro M.
        • Stewart E.T.
        • Panish J.
        • Ackroyd F.
        • Kurtz R.C.
        • Shike M.
        • National Polyp Study Workgroup
        Randomized comparison of surveillance intervals after colonoscopic removal of newly diagnosed adenomatous polyps.
        N Engl J Med. 1993; 328: 901-906
        • Hixson L.J.
        • Fennerty M.B.
        • Sampliner R.E.
        • Garewal H.S.
        Prospective blinded trial of the colonoscopic miss-rate of large colorectal polyps.
        Gastrointest Endosc. 1991; 37: 125-127
        • Rex D.K.
        • Cultler C.S.
        • Lemmel G.T.
        • Rahmani E.Y.
        • Clark D.W.
        • Helper D.J.
        • Lehman G.A.
        • Mark D.G.
        Colonoscopic miss rates of adenomas determined by back-to-back colonoscopies.
        Gastroenterology. 1997; 112: 24-98
        • Selby J.V.
        • Friedman G.D.
        • Quesenberry Jr, C.P.
        • Weiss N.S.
        A case-control study of screening sigmoidoscopy and mortality from colorectal cancer.
        N Engl J Med. 1992; 326: 653-657
        • Ahsan H.
        • Neugut A.I.
        • Garbowski G.C.
        • Jacobson J.S.
        • Forde K.A.
        • Treat M.R.
        • Waye J.D.
        Family history of colorectal adenomtous polyps and increased risk for colorectal cancer.
        Ann Intern Med. 1988; 128: 900-905
        • Winawer S.J.
        • Zauber A.G.
        • Gerdes H.
        • O’Brien M.J.
        • Gottlieb L.S.
        • Stermnberg S.S.
        • Bond J.H.
        • Waye J.D.
        • Schapiro M.
        • Panish J.F.
        • Kurtz R.C.
        • Shike M.
        • Ackroyd F.W.
        • Stewart E.T.
        • Skolnick M.
        • Bishop D.T.
        Risk of colorectal cancer in the families of patients with adenomatous polyps.
        N Engl J Med. 1996; 334: 82-87
        • Lynch K.L.
        • Ahnen D.J.
        • Byers T.
        • Weiss D.G.
        • Lieberman D.A.
        • VA Cooperative Study Group # 380
        First degree relatives of patients with advanced colorectal adenomas have an increased prevalence of colorectal cancer.
        Clin Gastroenterol Hepatol. 2003; 1: 96-102