Lower gastrointestinal symptoms are not predictive of colorectal neoplasia in a faecal occult blood screen-positive population

Background: The aim of this study was to evaluate the incidence of lower gastrointestinal symptoms in faecal occult blood (FOB) test‐positive participants in a colorectal screening programme, and to compare the colonoscopic findings in symptomatic and asymptomatic individuals. Methods: Five hundred and sixty‐three consecutive individuals with a positive FOB test in the Scottish arm of the national colorectal cancer screening pilot were studied. All were aged between 50 and 69 years and underwent colonoscopy. Before the procedure the participants were given a standard questionnaire to elicit gastrointestinal symptoms; these were correlated with the colonoscopic findings. Results: Of the 563 participants, 439 (78·0 per cent) had one or more lower gastrointestinal symptoms and 124 (22·0 per cent) were symptom free. Taking adenoma and carcinoma together, 322 (57·2 per cent) of the subjects were found to have colorectal neoplasia, and 128 (22·7 per cent) had a completely normal colon. Rectal bleeding was the most common symptom, followed by change in bowel habit, abdominal pain, tenesmus, unexplained weight loss, rectal pain and unexplained anaemia. No significant associations were found between any of these symptoms and the findings at colonoscopy. Conclusion: In a FOB test‐positive screened population, lower gastrointestinal symptoms are common, but are not predictive of colorectal neoplasia. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Useful in the emerging debate for symptomatic referral