triage and red flags
common symptoms
Common symptoms of lower-GI conditions are:
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Change in bowel habit, such as frequency, urgency, faecal incontinence or tenesmus
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Abdominal pain, cramping, bloating or excessive wind
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Rectal bleeding
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Weight loss
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Mucus in stools or fatty stools.
Symptoms may also include:
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Reduced appetite
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Nausea with or without vomiting
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Symptoms made worse with eating
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Persistent mouth ulcers
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Ongoing fatigue
case study: Debra’s story
Pathway applicability
The Primary Care Diagnostic Pathway for Lower-GI Symptoms aims to provide a logical diagnostic framework, including relevant investigations.
The pathway should be followed for patients presenting with lower-GI symptoms where:
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Minor self-limiting illness is unlikely
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Cancer is not being considered
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The patient is not acutely unwell
The pathway is NOT for patients who:
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Meet criteria for a possible cancer pathway
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Are acutely unwell
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Have worsening symptoms that require admission for emergency review, investigation or treatment
Jess’s rule encourages primary-care clinicians to rethink a diagnosis if a patient presents three times with the same symptoms¹
Red-flag referrals
Colorectal cancer symptoms
In the UK, there are around 44 100 new bowel cancer cases every year, making bowel cancer the fourth most common cancer in the UK.2
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More than nine out of ten new cases (94%) are diagnosed in people over the age of 50 years.3
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Faecal immunochemical testing (FIT) has a high sensitivity for the detection of colorectal cancer.5
Ovarian cancer symptoms
In the UK, there are around 7600 new ovarian cancer cases every year, making ovarian cancer the 16th most common cancer in the UK.6
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Nearly half of GPs (46%) mistakenly believe symptoms only present in the later stages of ovarian cancer.7
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Ovarian cancer incidence rates in England in females are similar in the most deprived quintile compared with the least.6
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CA125 and ultrasound play important roles in detecting ovarian cancer.8,9
44 100
new bowel cancer cases are diagnosed every year in the uk, making it the 4th most common cancer
46%
of gps mistakenly believe symptoms only present in later stages of ovarian cancer
Safety netting
Safety netting
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If symptoms persist or symptoms change – reassess (even if tests were negative) and consider referral
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Referrals should be based on clinical need
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If severe symptoms – urgent GI referral may still be needed
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Cancers of the upper-Gl tract (e.g. pancreatic or gastric cancer) or other systems
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Non-site-specific cancer pathway referral for persistent concerning symptoms
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Potential IBD or cancer despite negative or normal stool tests and ongoing symptoms
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False negative coeliac screen due to insufficient dietary gluten or immunoglobin A (IgA) deficiency, requiring tests for total IgA and IgG based serology
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Severe irritable bowel syndrome (IBS), which may need GI referral to optimise treatment
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Conditions of other systems (e.g. gynecological, hepatic or renal conditions)
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HIV screening for chronic diarrhoea
UK national cancer guidelines
England
Northern Ireland
scotland
Wales
KNOWLEDGE CHECK
Question 1/1
What is the most appropriate next step for a 74-year-old presenting with 4 months of diarrhoea and rectal bleeding (Hb 105g/L, CRP 32mg/L, FIT negative)?
click for REFERENCES
A digital learning tool designed to support primary care professionals in diagnosing lower-gastrointestinal symptoms using the national pathway.
