• Christoph Heintze, Dorothea Matysiak-Klose, Thorsten Kröhn, Ute Wolf, Alexander Brand, Christoph Meisner, Imma Fischer, Hartwig Wehrmeyer, and Vittoria Braun.
• Institute of General Medicine, Berlin, Germany. christoph.heintze@charite.de
• Br J Gen Pract. 2005 Jan 1; 55 (510): 141814-9; discussion 18.

BackgroundGPs have many patients with gastrointestinal discomfort. Among bowel-related complaints, the sign of rectal bleeding is of particular importance in patients aged 50 years and above, as it can be an early sign for serious bowel diseases such as colon carcinoma. Despite many guidelines offered to GPs for screening and early detection of colorectal carcinomas, there is very little information about the actual diagnostic approach to the sign of rectal bleeding.AimThe aim of the study was to collect data concerning treatment strategies used by GPs who treat patients presenting with rectal bleeding.Design Of StudyProspective data collection.SettingGeneral practices in Germany.MethodOver the course of a year, GPs recorded their treatment strategies in patients presenting with rectal bleeding and associated symptoms. Using a digital practice patient file, physicians participating in the study were able to continuously transmit data electronically to the researchers of the study about diagnostics, referrals, hospital admissions, and final diagnoses.ResultsDuring the course of 1 year, 94 participating physicians collected data on 1584 patients. Information about treating rectal bleeding was recorded for 422 patients; 60% of the patients were referred to specialists in internal medicine or gastroenterologists for further diagnostics. A colonoscopy was the most frequently performed diagnostic procedure (46.2%). Twenty-two per cent (n = 93) of the patients--54 of them aged 50 years and above--were exclusively treated by their GP without conducting a colonoscopy or cooperating with specialists. For these patients, GPs diagnosed less severe diseases like haemorrhoids or other proctologic diseases.ConclusionBy using a study that allows GPs to transmit electronically their findings and data, it is possible to draw a picture of treatment strategies of GPs in patients presenting with rectal bleeding. The high percentage of patients who received medical treatment in consultation with specialists underscores the significance of the sign of rectal bleeding in general practice. The need for further diagnostic measures in patients who have been treated exclusively by GPs has to be discussed.

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