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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, Barretts esophagus, ulcerative colitis/Crohns 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.

Specific Instructions
None
Availability

Available

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. Barretts esophagus

[ ] No

[ ] Yes

If Yes, year of diagnosis ________

2g. Ulcerative colitis/Crohns 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[ ]+

*Editors 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."

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

Lifestage

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.

Selection Rationale

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

Language

Chinese, English

Standards
StandardNameIDSource
Logical Observation Identifiers Names and Codes (LOINC) Pers hx GI conditions proto 62971-7 LOINC
Human Phenotype Ontology Abnormality of the gastrointestinal tract HP:0011024 HPO
caDSR Form PhenX PX191001 - Personal History Of Gastrointestinal Conditions 6195045 caDSR Form
Derived Variables

None

Process and Review

Not applicable.

Protocol Name from Source

National Heart, Lung, and Blood Institute (NHLBI) and National Cancer Institute (NCI), Health Professionals Follow-Up Study, 2008

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 Name Variable IDVariable DescriptiondbGaP Mapping
PX191001_Barretts_Esophagus
PX191001020600 Have you had any of the following clinician more
diagnosed conditions? Barrett's esophagus? show less
N/A
PX191001_Barretts_Esophagus_Year_Of_Diagnosis
PX191001020601 Have you had any of the following clinician more
diagnosed conditions? Barrett's esophagus? If Yes, year of diagnosis show less
N/A
PX191001_Bleeding_Year_1993_1997
PX191001030202 What year(s) did this happen? (Mark all that more
apply.) 1993-1997 show less
N/A
PX191001_Bleeding_Year_1998_1999
PX191001030203 What year(s) did this happen? (Mark all that more
apply.) 1998-1999 show less
N/A
PX191001_Bleeding_Year_2000_2001
PX191001030204 What year(s) did this happen? (Mark all that more
apply.) 2000-2001 show less
N/A
PX191001_Bleeding_Year_2002_2003
PX191001030205 What year(s) did this happen? (Mark all that more
apply.) 2002-2003 show less
N/A
PX191001_Bleeding_Year_2004_2005
PX191001030206 What year(s) did this happen? (Mark all that more
apply.) 2004-2005 show less
N/A
PX191001_Bleeding_Year_Before_1993
PX191001030201 What year(s) did this happen? (Mark all that more
apply.) Before 1993 show less
N/A
PX191001_Bleeding_Year_Before_2006+
PX191001030207 What year(s) did this happen? (Mark all that more
apply.) 2006+ show less
N/A
PX191001_Cancer_Of_Colon_Or_Rectum
PX191001020300 Have you had any of the following clinician more
diagnosed conditions? Cancer of colon or rectum? show less
Variable Mapping
PX191001_Cancer_Year_Of_Diagnosis
PX191001020301 Have you had any of the following clinician more
diagnosed conditions? Cancer of colon or rectum? If Yes, year of diagnosis show less
Variable Mapping
PX191001_Colonoscopy
PX191001010201 In the past 2 years, have you had... a more
colonoscopy? show less
N/A
PX191001_Colon_Or_Rectal_Polyp
PX191001020200 Have you had any of the following clinician more
diagnosed conditions? Colon or rectal polyp? show less
Variable Mapping
PX191001_Diverticulitis_Or_Diverticulosis
PX191001020100 Have you had any of the following clinician more
diagnosed conditions? Diverticulitis or Diverticulosis? show less
Variable Mapping
PX191001_Diverticulitis_Year_Of_Diagnosis
PX191001020101 Have you had any of the following clinician more
diagnosed conditions? Diverticulitis or Diverticulosis? If Yes, year of diagnosis show less
N/A
PX191001_Gall_Bladder_Removal
PX191001020400 Have you had any of the following clinician more
diagnosed conditions? Gall bladder removal? show less
Variable Mapping
PX191001_Gall_Bladder_Removal_Year_OfDiagnosis
PX191001020401 Have you had any of the following clinician more
diagnosed conditions? Gall bladder removal? If Yes, year of diagnosis show less
N/A
PX191001_Gastric_Or_Duodenal_Ulcer
PX191001020500 Have you had any of the following clinician more
diagnosed conditions? Gastric or duodenal ulcer? show less
Variable Mapping
PX191001_Gastrointestinal_Bleeding
PX191001030000 Have you ever had gastrointestinal bleeding more
that required hospitalization or a transfusion? show less
N/A
PX191001_Polyp_Year_Of_Diagnosis
PX191001020201 Have you had any of the following clinician more
diagnosed conditions? Colon or rectal polyp? If Yes, year of diagnosis show less
N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Abdominal_Pain
PX191001010307 Initial reason(s) you had a more
colonoscopy/sigmoidoscopy? Abdominal pain show less
N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Barium_Enema
PX191001010308 Initial reason(s) you had a more
colonoscopy/sigmoidoscopy? Barium enema show less
N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Diarrhea_Constipation
PX191001010305 Initial reason(s) you had a more
colonoscopy/sigmoidoscopy? Diarrhea/constipation show less
N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Family_History
PX191001010302 Initial reason(s) you had a more
colonoscopy/sigmoidoscopy? Family history of colon cancer show less
N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Fecal_Blood
PX191001010304 Initial reason(s) you had a more
colonoscopy/sigmoidoscopy? Occult fecal blood show less
N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Prior_Polyps
PX191001010306 Initial reason(s) you had a more
colonoscopy/sigmoidoscopy? Prior polyps show less
N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Routine_Screening
PX191001010309 Initial reason(s) you had a more
colonoscopy/sigmoidoscopy? Asymptomatic or routine screening show less
N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Virtual_Colonography
PX191001010303 Initial reason(s) you had a more
colonoscopy/sigmoidoscopy? Virtual (CT) colonography show less
N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Visible_Blood
PX191001010301 Initial reason(s) you had a more
colonoscopy/sigmoidoscopy? Visible blood show less
N/A
PX191001_Sigmoidoscopy
PX191001010202 In the past 2 years, have you had... a more
sigmoidoscopy? show less
N/A
PX191001_Site_Of_The_Bleeding_Colon/Rectum
PX191001030104 What was the site of the bleeding? (Mark all more
that apply.) Colon/Rectum show less
N/A
PX191001_Site_Of_The_Bleeding_Duodenum
PX191001030103 What was the site of the bleeding? (Mark all more
that apply.) Duodenum show less
N/A
PX191001_Site_Of_The_Bleeding_Esophagus
PX191001030101 What was the site of the bleeding? (Mark all more
that apply.) Esophagus show less
N/A
PX191001_Site_Of_The_Bleeding_Other
PX191001030105 What was the site of the bleeding? (Mark all more
that apply.) Other show less
N/A
PX191001_Site_Of_The_Bleeding_Stomach
PX191001030102 What was the site of the bleeding? (Mark all more
that apply.) Stomach show less
N/A
PX191001_Site_Of_The_Bleeding_Unkown
PX191001030106 What was the site of the bleeding? (Mark all more
that apply.) Unknown show less
N/A
PX191001_Ulcerative_ColitisCrohns_Disease
PX191001020700 Have you had any of the following clinician more
diagnosed conditions? Ulcerative colitis/Crohn's disease show less
Variable Mapping
PX191001_Ulcerative_ColitisCrohns_Year_Of_Diagnosis
PX191001020701 Have you had any of the following clinician more
diagnosed conditions? Ulcerative colitis/Crohn's disease? If Yes, year of diagnosis show less
Variable Mapping
PX191001_Ulcer_Year_Of_Diagnosis
PX191001020501 Have you had any of the following clinician more
diagnosed conditions? Gastric or duodenal ulcer? If Yes, year of diagnosis show less
N/A
PX191001_Upper_Endoscopy
PX191001010100 In the past 2 years, have you had... an more
upper endoscopy (esophagus/stomach)? show less
N/A
PX191001_Virtual_Ct_Colonoscopy
PX191001010200 In the past 2 years, have you had... a more
(Virtual) CT colonoscopy? show less
N/A
Gastrointestinal
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, Crohns disease, ulcerative colitis, colon or rectal polyps, gastric ulcers, Barretts esophagus, gastrointestinal bleeding, Gastrointestinal

Measure Protocols
Protocol ID Protocol Name
191001 Personal History of Gastrointestinal Conditions
Publications

There are no publications listed for this protocol.