Abdominal pain in primary care: establishing a clinical profile and diagnostic pathway for identifying cancer

 

Introduction

Abdominal pain (AP) is a symptom commonly reported to United Kingdom (UK) general practitioners (GPs). It can be a symptom of both transient illness and serious disease; often making its cause difficult for GPs to diagnose. This ambiguity influences GP decision making, such as where to refer the patient for further investigation – thus potentially causing delays in diagnosis. Existing research has shown abdominal pain to be a prior symptom of nine different cancers.

These patients currently do not have an effective diagnostic pathway, although the NHS’s Accelerate Coordinate Evaluate (ACE) programme is piloting new diagnostic pathways for patients with non-specific but concerning symptoms using multidisciplinary diagnostic centres (MDC).

Project team

Aims & Objectives

Using Clinical Practice Research Datalink (CPRD) data to study a large dataset of patients aged ≥40 with new onset abdominal pain. We will identify diagnoses of cancer within 24 months of this abdominal pain episode.

Objectives:

What are the other diagnoses within 24 months of presentation with abdominal pain?

Methodology

This is a prospective cohort study of CPRD patients with new unexplained abdominal pain occurring between 1st January 2009 and 31st December 2013.

We will study 150,000 cases (75,000 males) with a new (no history of AP in last year) record of unexplained abdominal pain in primary care, aged 40 and over, between January 2009 and December 2013. 30,000 cases (15,000 males) will be recruited in each of the age bands: 40-49; 50-59; 60-69; 70-79; 80+.

We estimate that this sample will include 4500 patients with cancer.

Outputs & impact

The intended outcome of this research is to improve the diagnostic accuracy of patients in the UK with unexplained abdominal pain, thereby reducing diagnostic waiting times, reducing the number of unnecessary specialist referrals and therefore improving patient experience.

Next steps

The outcomes of this study will also inform potential future models of care/service options: would patients be best served by referral to a symptom specific multi-disciplinary diagnostic clinic (MDDC) or by GPs within the general practice surgery?  New specialist clinics have been established, but have no relevant evidence to help them select the best sequence of tests for patients. The results are applicable to national and international service providers.

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