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Protocol - Personal History of Gastrointestinal Conditions

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Description:

This self-administered questionnaire asks respondents about their personal history of several gastrointestinal conditions including colon or rectal polyps, gallbladder conditions, gastric ulcers, Barrett's esophagus, ulcerative colitis/Crohn's disease, colon or rectal cancer, pancreatic cancer, and gastrointestinal bleeding. The questionnaire also asks about a history of gastrointestinal procedures such as a colonoscopy, a sigmoidoscopy, and an upper endoscopy.

Protocol:

1. In the past 2 years, have you had a…

1a. upper endoscopy (esophagus/stomach)?

[] No

[] Yes

1b. a (Virtual) CT colonoscopy?

[] No

[] Yes

1b1. a colonoscopy?

[] No

[] Yes

1b2. a sigmoidoscopy?

[] No

[] Yes

If Yes to 1b1 or 1b2:

1c. Initial reason(s) you had a colonoscopy/sigmoidoscopy?

[] visible blood

[] family history of colon cancer

[] Virtual (CT) colonography

[] occult fecal blood

[] diarrhea/constipation

[] prior polyps

[] abdominal pain

[] barium enema

[] asymptomatic or routine screening

2. Have you had any of the following clinician diagnosed conditions?*

2a. Diverticulitis or Diverticulosis

[] No

[] Yes

If Yes, year of diagnosis ________

2b. Colon or rectal polyp

[] No

[] Yes

If Yes, year of diagnosis ________

2c. Cancer of colon or rectum

[] No

[] Yes

If Yes, year of diagnosis ________

2d. Gall bladder removal

[] No

[] Yes

If Yes, year of diagnosis ________

2e. Gastric or duodenal ulcer

[] No

[] Yes

If Yes, year of diagnosis ________

2f. Barrett's esophagus

[] No

[] Yes

If Yes, year of diagnosis ________

2g. Ulcerative colitis/Crohn's disease

[] No

[] Yes

If Yes, year of diagnosis ________

3. Have you ever had gastrointestinal bleeding that required hospitalization or a transfusion?

[] Yes

[] No

If Yes

3a. What was the site of the bleeding? (Mark all that apply.)

[] Esophagus

[] Stomach

[] Duodenum

[] Colon/Rectum

[] Other

[] Site unknown

3b. What year(s) did this happen? (Mark all that apply.)

[] Before 1993

[] 1993–1997

[] 1998–1999

[] 2000–2001

[] 2002–2003

[] 2004–2005

[] 2006 +

*Editor's Note: The Gastrointestinal Working Group (WG) slightly modified this question from the original protocol text. The original protocol obtains year of diagnosis by asking respondents to choose between four choices (Before 2006, 2006, 2007, or 2008). The Gastrointestinal WG removed the phrase "Since January 1, 2006" to allow collection of diagnoses that occurred prior to that time. The original response options were deleted and respondents are now asked to write in the four-digit year of diagnosis if they respond "Yes."

Protocol Name from Source:

This section will be completed when reviewed by an Expert Review Panel.

Availability:

Publicly available

Personnel and Training Required
None
Equipment Needs
None
Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Self-administered questionnaire

Life Stage:

Adult

Participants:

Adult males in health professions* *Although this protocol was used in a study of men in health professions, the Gastrointestinal Working Group deems it appropriate to use with all adult men and women.

Specific Instructions:
None
Selection Rationale

The Health Professionals Follow-Up Study has been conducted since 1986 and is a reliable and valid protocol.

Language

English

Standards
StandardNameIDSource
Common Data Elements (CDE) Person Gastrointestinal Condition Personal Medical History 3163069 CDE Browser
Logical Observation Identifiers Names and Codes (LOINC) Pers hx GI conditions proto 62971-7 LOINC
Derived Variables

None

Process and Review

This section will be completed when reviewed by an Expert Review Panel.

Source

U.S. Department of Health and Human Services. National Institutes of Health. National Heart, Lung, and Blood Institute and National Cancer Institute. Health Professionals Follow-Up Study. 2008.

General References

None

Protocol ID:

191001

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX191001_Barretts_Esophagus PX191001020600 Have you had any of the following clinician diagnosed conditions? Barrett's esophagus? 4 N/A
PX191001_Barretts_Esophagus_Year_Of_Diagnosis PX191001020601 Have you had any of the following clinician diagnosed conditions? Barrett's esophagus? If Yes, year of diagnosis 4 N/A
PX191001_Bleeding_Year_1993-1997 PX191001030202 What year(s) did this happen? (Mark all that apply.) 1993-1997 4 N/A
PX191001_Bleeding_Year_1998_1999 PX191001030203 What year(s) did this happen? (Mark all that apply.) 1998-1999 4 N/A
PX191001_Bleeding_Year_2000_2001 PX191001030204 What year(s) did this happen? (Mark all that apply.) 2000-2001 4 N/A
PX191001_Bleeding_Year_2002_2003 PX191001030205 What year(s) did this happen? (Mark all that apply.) 2002-2003 4 N/A
PX191001_Bleeding_Year_2004_2005 PX191001030206 What year(s) did this happen? (Mark all that apply.) 2004-2005 4 N/A
PX191001_Bleeding_Year_Before_1993 PX191001030201 What year(s) did this happen? (Mark all that apply.) Before 1993 4 N/A
PX191001_Bleeding_Year_Before_2006+ PX191001030207 What year(s) did this happen? (Mark all that apply.) 2006+ 4 N/A
PX191001_Cancer_Of_Colon_Or_Rectum PX191001020300 Have you had any of the following clinician diagnosed conditions? Cancer of colon or rectum? 4 N/A
PX191001_Cancer_Year_Of_Diagnosis PX191001020301 Have you had any of the following clinician diagnosed conditions? Cancer of colon or rectum? If Yes, year of diagnosis 4 N/A
PX191001_Colonoscopy PX191001010201 In the past 2 years, have you had... a colonoscopy? 4 N/A
PX191001_Colon_Or_Rectal_Polyp PX191001020200 Have you had any of the following clinician diagnosed conditions? Colon or rectal polyp? 4 N/A
PX191001_Diverticulitis_Or_Diverticulosis PX191001020100 Have you had any of the following clinician diagnosed conditions? Diverticulitis or Diverticulosis? 4 N/A
PX191001_Diverticulitis_Year_Of_Diagnosis PX191001020101 Have you had any of the following clinician diagnosed conditions? Diverticulitis or Diverticulosis? If Yes, year of diagnosis 4 N/A
PX191001_Gall_Bladder_Removal PX191001020400 Have you had any of the following clinician diagnosed conditions? Gall bladder removal? 4 N/A
PX191001_Gall_Bladder_Removal_Year_OfDiagnosis PX191001020401 Have you had any of the following clinician diagnosed conditions? Gall bladder removal? If Yes, year of diagnosis 4 N/A
PX191001_Gastric_Or_Duodenal_Ulcer PX191001020500 Have you had any of the following clinician diagnosed conditions? Gastric or duodenal ulcer? 4 N/A
PX191001_Gastrointestinal_Bleeding PX191001030000 Have you ever had gastrointestinal bleeding that required hospitalization or a transfusion? 4 N/A
PX191001_Polyp_Year_Of_Diagnosis PX191001020201 Have you had any of the following clinician diagnosed conditions? Colon or rectal polyp? If Yes, year of diagnosis 4 N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Abdominal_Pain PX191001010307 Initial reason(s) you had a colonoscopy/sigmoidoscopy? Abdominal pain 4 N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Barium_Enema PX191001010308 Initial reason(s) you had a colonoscopy/sigmoidoscopy? Barium enema 4 N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Diarrhea_Constipation PX191001010305 Initial reason(s) you had a colonoscopy/sigmoidoscopy? Diarrhea/constipation 4 N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Family_History PX191001010302 Initial reason(s) you had a colonoscopy/sigmoidoscopy? Family history of colon cancer 4 N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Fecal_Blood PX191001010304 Initial reason(s) you had a colonoscopy/sigmoidoscopy? Occult fecal blood 4 N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Prior_Polyps PX191001010306 Initial reason(s) you had a colonoscopy/sigmoidoscopy? Prior polyps 4 N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Routine_Screening PX191001010309 Initial reason(s) you had a colonoscopy/sigmoidoscopy? Asymptomatic or routine screening 4 N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Virtual_Colonography PX191001010303 Initial reason(s) you had a colonoscopy/sigmoidoscopy? Virtual (CT) colonography 4 N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Visible_Blood PX191001010301 Initial reason(s) you had a colonoscopy/sigmoidoscopy? Visible blood 4 N/A
PX191001_Sigmoidoscopy PX191001010202 In the past 2 years, have you had... a sigmoidoscopy? 4 N/A
PX191001_Site_Of_The_Bleeding_Colon/Rectum PX191001030104 What was the site of the bleeding? (Mark all that apply.) Colon/Rectum 4 N/A
PX191001_Site_Of_The_Bleeding_Duodenum PX191001030103 What was the site of the bleeding? (Mark all that apply.) Duodenum 4 N/A
PX191001_Site_Of_The_Bleeding_Esophagus PX191001030101 What was the site of the bleeding? (Mark all that apply.) Esophagus 4 N/A
PX191001_Site_Of_The_Bleeding_Other PX191001030105 What was the site of the bleeding? (Mark all that apply.) Other 4 N/A
PX191001_Site_Of_The_Bleeding_Stomach PX191001030102 What was the site of the bleeding? (Mark all that apply.) Stomach 4 N/A
PX191001_Site_Of_The_Bleeding_Unkown PX191001030106 What was the site of the bleeding? (Mark all that apply.) Unknown 4 N/A
PX191001_Ulcerative_ColitisCrohns_Disease PX191001020700 Have you had any of the following clinician diagnosed conditions? Ulcerative colitis/Crohn's disease 4 N/A
PX191001_Ulcerative_ColitisCrohns_Year_Of_Diagnosis PX191001020701 Have you had any of the following clinician diagnosed conditions? Ulcerative colitis/Crohn's disease? If Yes, year of diagnosis 4 N/A
PX191001_Ulcer_Year_Of_Diagnosis PX191001020501 Have you had any of the following clinician diagnosed conditions? Gastric or duodenal ulcer? If Yes, year of diagnosis 4 N/A
PX191001_Upper_Endoscopy PX191001010100 In the past 2 years, have you had... an upper endoscopy (esophagus/stomach)? 4 N/A
PX191001_Virtual_Ct_Colonoscopy PX191001010200 In the past 2 years, have you had... a (Virtual) CT colonoscopy? 4 N/A
Research Domain Information
Measure Name:

Personal History of Gastrointestinal Conditions

Release Date:

December 13, 2010

Definition

This is a measure to assess personal history of gastrointestinal conditions and procedures.

Purpose

Personal history of gastrointestinal conditions and procedures is important to investigate in order to track progress of a condition and predict risk factors for other related conditions.

Keywords

Gastrointestinal conditions, personal history, gallbladder, Crohn's disease, ulcerative colitis, colon or rectal polyps, gastric ulcers, Barrett's esophagus, gastrointestinal bleeding, Gastrointestinal