Altered bowel habit – loose stool (diarrhoea), constipation or both. There is a broad list of potential diagnoses that may cause these symptoms, including inflammatory bowel disease, irritable bowel syndrome, coeliac disease and microscopic colitis. Colonic polyps or bowel cancer are potential causes of altered bowel habit.
Rectal bleeding – this may be due to a number of different conditions including haemorrhoids, colonic polyps, or even bowel cancer. Polyps are small growths within the large bowel which have the potential to turn into bowel cancer in the long term. Polyps are usually under 1 cm in size, however may be larger than this. The majority of colonic polyps can be safely excised / removed during colonoscopy
Abdominal pain – depending upon the site of the pain, this also has a number of different possible diagnoses. Common conditions include gallstones, peptic ulcer disease, gastro-oesophageal reflux, and functional dyspepsia.
Family history of bowel cancer or previous colonic polyps – depending upon the history, regular surveillance with colonoscopy to detect and remove polyps may be appropriate. Those with previous colonic polyps have an increased risk of developing further polyps in the future.
Postive faecal occult blood test – for example through the National Bowel Cancer Screening Program. This is a screening test, and a positive result almost always warrants colonoscopy as those with a positive test have an increased risk of colonic polyps, and indeed a small risk of bowel cancer at colonoscopy. If bowel cancer is detected, it is often found at an early stage where it can be much more easily treated.
Iron deficiency anaemia – This may be due to bleeding from the gut even in the absence of symptoms. Depending upon the history and blood test results, further investigation is usually warranted. Clinical update about iron deficiency.
Inflammatory bowel disease – Crohn’s disease and ulcerative colitis. The aim of treatment is to maximise the patient’s quality of life and minimise the risk of complications in the long term. Treatment of inflammatory bowel disease is often complex and treatment by a specialist with an interest is inflammatory bowel disease is warranted in almost all cases. Information sheet
Gastro-oesophageal reflux (GORD) – reflux of acid from the stomach into the oesophagus, often causing heartburn or indigestion. In some cases reflux can lead to reflux oesophagitis (inflammation of the oesophagus). Those with poorly controlled reflux are at risk of developing Barrett’s oesophagus (a change in the lining of the lower oesophagus which has an increased risk of cancer of the oesophagus in the long term). Surveillance gastroscopy every 2-3 years should be considered for patients with proven Barrett’s oesophagus. Information sheet about reflux
Swallowing difficulties (‘dysphagia’). This has a broad differential diagnosis, including oesophageal strictures, oesophageal cancer, oesophageal motility problems and eosinophilic oesophagitis. Dysphagia is almost always an indication for diagnostic gastroscopy