17.1% of ultrasounds. Of patients with adequate imaging, 67 (46.9%) had pancreatic abnormalities detected; including 31 with chronic pancreatitis and 7 pancreaticobiliary cancers. 124 patients (68.1%) had nutritional blood tests sent. Of these, 65 (52.4%) had one or more abnormal result.103 patients (56.6%) received PERT; median initial dose 50000 IU/meal. 77 patients (66.4%) were referred to dietetics. 67 patients (81.7%) responded clinically to PERT. Patients with severe PEI were no more likely to respond than those with mild PEI (OR 1.28, 95% CI 0.40-4.03; p=0.68). Initial PERT dose was not associated with clinical response (OR 1.00, 95% CI 1.00-1.00; p=0.51), nor was referral to dietetics (OR 0.61, 95% CI 0.12-3.04; p=0.54). However, patients with abnormal pancreatic imaging or nutritional blood tests had four times the odds of responding to PERT than those with normal results (OR 4.77, p=0.03, and OR 4.12, p=0.04). Conclusions All patients diagnosed with PEI should be screened for malnutrition and undergo pancreatic imaging with CT or MRI. Abnormal results are common and may predict response to treatment.
endoscopic modality but 75% had anal pathology including haemorrhoids, fissures, skin tags or prolapse. In patients 30-39 yrs, two had rectal tumours (1.1%) and twelve had adenomatous polyps (6.6%), five of these being high risk polyps (2.7%). There were no tumours in patients 40-49 yrs but 23 had adenomatous polyps (13.0%), eleven of these being high risk (6.2%). In the >50 yrs comparison group, ten had colorectal tumours (3.5%) and 58 had adenomatous polyps (20.6%), 24 of these being high risk (8.5%). Colonoscopy overall comparatively had a much higher pick up rate than limited colonoscopy in all age groups. For <50 yrs colonoscopy had an adenomatous polyp identification rate of 14.7% compared to 7.0% on limited colonoscopy. >50 yrs was similar with colonoscopy having a rate of 24.6% compared with 10.8% on limited colonoscopy. Conclusions This study concludes endoscopy would be necessary to evaluate low risk rectal bleeding in patients aged 30-49 yrs given the rate of significant pathology found, with colonoscopy being the preferred modality due to its much higher identification rate. Patients under 30 with low risk rectal bleeding could be examined in clinic for anal pathology. If no anal bleeding source is found further endoscopic investigation should be considered.
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