History

History of present illness

Most patients with colonic polyps are asymptomatic. In symptomatic patients, the most common presenting symptom is rectal bleeding. Other symptoms include diarrhea or constipation, often with decreased stool caliber.

Villous adenomas of the rectum and the distal colon can occasionally manifest as a syndrome of severe diarrhea with massive fluid and electrolyte loss.

Chronic bleeding from colonic polyps may cause iron deficiency anemia.

Family history

Although colonic polyps are a disease of older individuals, a positive family history of polyposis should prompt referral for screening in younger individuals and, in some cases, at more frequent intervals. A common practice is to begin screening in a patient 5 years earlier than the age at which colonic polyps were diagnosed in a first-degree relative.

Physical Examination

Distal rectal polyps can be detected by digital rectal examination. Otherwise, physical examination findings are typically normal.

Occult blood in stools (detected by guaiac and antibody-based tests) may be found in a minority of patients with colonic polyps. Although nonspecific, this finding should prompt a colon evaluation in most patients. Such evaluations have had similar yields of clinically significant findings whether the stool sample was obtained by digital rectal examination or was retrieved from spontaneously passed stools.

Differential Diagnoses

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Media Gallery

Familial adenomatous polyposis, total colectomy specimen. The colonic mucosa is studded with innumerable sessile and small pedunculated polyps, which involve the entire length of the specimen.
Multiple large polyps in the colon. The polyp in the center of the image is situated on a stalk. (Endoscopic image).

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Author

Gregory H Enders, MD, PhD Gastroenterologist, Moses Taylor Hospital, Regional Hospital of Scranton, and Physicians Health Alliance

Gregory H Enders, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American Gastroenterological Association

Disclosure: Nothing to disclose.

Coauthor(s)

Wafik S El-Deiry, MD, PhD Rose Dunlap Professor of Medicine, Chief, Division of Hematology and Oncology, Penn State Hershey Medical Center

Wafik S El-Deiry, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Society for Clinical Investigation, American Society of Gene and Cell Therapy

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Manoop S Bhutani, MD Professor, Co-Director, Center for Endoscopic Research, Training and Innovation (CERTAIN), Director, Center for Endoscopic Ultrasound, Department of Medicine, Division of Gastroenterology, University of Texas Medical Branch; Director, Endoscopic Research and Development, The University of Texas MD Anderson Cancer Center

Manoop S Bhutani, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Institute of Ultrasound in Medicine, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Acknowledgements

Research on colon neoplasia in the author's laboratory has been supported by NIH grant #R01DK64758.