Diagnoses after newly recorded abdominal pain in primary care: observational cohort study

The British journal of general practice: the journal of the Royal College of General Practitioners

article

Sarah J Price¹  Niamh Gibson²  William T Hamilton¹  Jennifer Bostock³  Elizabeth A Shephard¹ 

[1] Cancer Diagnosis ,(DISCO), University of Exeter Medical School;University of Exeter Medical School;Policy Research Unit on Cancer Awareness, Screening and Early Diagnosis, Queen Mary University of London

关键词: abdominal pain;    diagnosis;    general practice;    urinary tract infections;    diverticular diseases;    primary health care;   

DOI  :  10.3399/BJGP.2021.0709

学科分类：卫生学

来源: Royal College of General Practitioners

【 摘 要 】

Background Non-acute abdominal pain in primary care is diagnostically challenging.Aim To quantify the 1-year cumulative incidence of 35 non-malignant diagnoses and nine cancers in adults after newly recorded abdominal pain in primary care.Design and setting Observational cohort study of 125 793 Clinical Practice Research Datalink GOLD records.Method Participants, aged ≥40 years, had newly recorded abdominal pain between 1 January 2009 and 31 December 2013. Age- and sex-stratified 1-year cumulative incidence by diagnosis is reported.Results70%) participants had no pre-specified diagnoses after newly recorded abdominal pain. Non-malignant diagnoses were most common: upper gastrointestinal problems (gastro-oesophageal reflux disease, hiatus hernia, gastritis, oesophagitis, and gastric/duodenal ulcer) in males and urinary tract infection in females. The incidence of upper gastrointestinal problems plateaued at age ≥60 years (aged 40–59 years: males 4.9%, 95% confidence interval [CI] = 4.6 to 5.1, females 4.0%, 95% CI = 3.8 to 4.2; aged 60–69 years: males 5.8%, 95% CI = 5.4 to 6.2, females 5.4%, 95% CI = 5.1 to 5.8). Urinary tract infection incidence increased with age (aged 40–59 years: females 5.1%, 95% CI = 4.8 to 5.3, males 1.1%, 95% CI = 1.0 to 1.2; aged ≥70 years: females 8.0%, 95% CI = 7.6 to 8.4, males 3.3%, 95% CI = 3.0 to 3.6%). Diverticular disease incidence rose with age, plateauing at 4.2% (95% CI = 3.9 to 4.6) in males aged ≥60 years, increasing to 6.1% (95% CI = 5.8 to 6.4) in females aged ≥70 years. Irritable bowel syndrome incidence was higher in females (aged 40–59 years: 2.9%, 95% CI = 2.7 to 3.1) than males (aged 40–59 years: 2.1%, 95% CI = 1.9 to 2.3), decreasing with age to 1.3% (95% CI = 1.2 to 1.5) in females and 0.6% (95% CI = 0.5 to 0.8) in males aged ≥70 years.Conclusion Although abdominal pain commonly remains unexplained, non-malignant diagnosis are more likely than cancer.

【 授权许可】

Free