A SIMPLE SCORE FOR THE IDENTIFICATION OF PATIENTS AT HIGH-RISK OF ORGANIC DISEASES OF THE COLON IN THE FAMILY DOCTOR CONSULTING ROOM

In order to develop a scoring system for selecting patients at high risk of organic diseases of the colon, who would need a conoloscopy or a barium enema, we conducted a study with 14 GPs in the local health care district of Modena. Over one year, 254 consecutive patients who consulted their GP for chronic abdominal pain were asked to answer a guided questionnaire. A checklist of simple parameters suggestive of the presence of organic diseases of the colon was also registered by the GP. For the final diagnosis, the patients underwent either a colonscopy or a barium enema. Data collected were analysed by means of a stepwise logistic regression analysis to obtain a weighted score for the diagnosis of either irritable bowel syndrome (score < 0) or organic disease (score > 0). Out of the 25 parameters explored, six were significantly more common among patients with organic disease and weighted as positive score (namely ESR > 17 mm, first hour, history of blood in the stool, leukocytosis > 10 000 cm3, age > 45 years, slight fever and presence of neoplastic colonic diseases in first-degree relatives). On the contrary, five parameters were more frequent among patients with irritable bowel syndrome and weighted as negative score (namely visible distension of the abdomen, feeling of distension, presence of irritable bowel syndrome in first degree relatives, flatulence and irregularities of bowel movement). Our scoring system correctly classified 83.5% of the cases, and it was very sensitive (82.4%) for the diagnosis of organic disease. The sensitivity decreased progressively for cancer, inflammatory bowel disease polyposis and diverticula. All cancers were correctly classified with a positive score far from 0. Our score is simple and cheap, and it deserves testing for its usefulness in the selection of patients who need more invasive diagnostic procedures.