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Protocol - Personal History of Gastrointestinal Conditions

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Protocol Name from Source:

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

Availability:

Publicly available

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."

Personnel and Training Required

None

Equipment Needs

None

Requirements

Requirement CategoryRequired
Average time of greater than 15 minutes in an unaffected individualNo
Major equipmentNo
Specialized requirements for biospecimen collectionNo
Specialized trainingNo

Mode of Administration

Self-administered

Life Stage:

Adult

Specific Instructions:

None
Research Domain Information

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.

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 History3163069CDE Browser
Logical Observation Identifiers Names and Codes (LOINC)Pers hx GI conditions proto62971-7LOINC

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_Upper_EndoscopyPX191001010100In the past 2 years, have you had... an upper endoscopy (esophagus/stomach)?4N/A
PX191001_Virtual_Ct_ColonoscopyPX191001010200In the past 2 years, have you had... a (Virtual) CT colonoscopy?4N/A
PX191001_ColonoscopyPX191001010201In the past 2 years, have you had... a colonoscopy?4N/A
PX191001_SigmoidoscopyPX191001010202In the past 2 years, have you had... a sigmoidoscopy?4N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Visible_BloodPX191001010301Initial reason(s) you had a colonoscopy/sigmoidoscopy? Visible blood4N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Family_HistoryPX191001010302Initial reason(s) you had a colonoscopy/sigmoidoscopy? Family history of colon cancer4N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Virtual_ColonographyPX191001010303Initial reason(s) you had a colonoscopy/sigmoidoscopy? Virtual (CT) colonography4N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Fecal_BloodPX191001010304Initial reason(s) you had a colonoscopy/sigmoidoscopy? Occult fecal blood4N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Diarrhea_ConstipationPX191001010305Initial reason(s) you had a colonoscopy/sigmoidoscopy? Diarrhea/constipation4N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Prior_PolypsPX191001010306Initial reason(s) you had a colonoscopy/sigmoidoscopy? Prior polyps4N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Abdominal_PainPX191001010307Initial reason(s) you had a colonoscopy/sigmoidoscopy? Abdominal pain4N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Barium_EnemaPX191001010308Initial reason(s) you had a colonoscopy/sigmoidoscopy? Barium enema4N/A
PX191001_Reason_Had_Colonoscopy_Sigmoidoscopy_Routine_ScreeningPX191001010309Initial reason(s) you had a colonoscopy/sigmoidoscopy? Asymptomatic or routine screening4N/A
PX191001_Diverticulitis_Or_DiverticulosisPX191001020100Have you had any of the following clinician diagnosed conditions? Diverticulitis or Diverticulosis?4N/A
PX191001_Diverticulitis_Year_Of_DiagnosisPX191001020101Have you had any of the following clinician diagnosed conditions? Diverticulitis or Diverticulosis? If Yes, year of diagnosis4N/A
PX191001_Colon_Or_Rectal_PolypPX191001020200Have you had any of the following clinician diagnosed conditions? Colon or rectal polyp?4N/A
PX191001_Polyp_Year_Of_DiagnosisPX191001020201Have you had any of the following clinician diagnosed conditions? Colon or rectal polyp? If Yes, year of diagnosis4N/A
PX191001_Cancer_Of_Colon_Or_RectumPX191001020300Have you had any of the following clinician diagnosed conditions? Cancer of colon or rectum?4N/A
PX191001_Cancer_Year_Of_DiagnosisPX191001020301Have you had any of the following clinician diagnosed conditions? Cancer of colon or rectum? If Yes, year of diagnosis4N/A
PX191001_Gall_Bladder_RemovalPX191001020400Have you had any of the following clinician diagnosed conditions? Gall bladder removal?4N/A
PX191001_Gall_Bladder_Removal_Year_OfDiagnosisPX191001020401Have you had any of the following clinician diagnosed conditions? Gall bladder removal? If Yes, year of diagnosis4N/A
PX191001_Gastric_Or_Duodenal_UlcerPX191001020500Have you had any of the following clinician diagnosed conditions? Gastric or duodenal ulcer?4N/A
PX191001_Ulcer_Year_Of_DiagnosisPX191001020501Have you had any of the following clinician diagnosed conditions? Gastric or duodenal ulcer? If Yes, year of diagnosis4N/A
PX191001_Barretts_EsophagusPX191001020600Have you had any of the following clinician diagnosed conditions? Barrett's esophagus?4N/A
PX191001_Barretts_Esophagus_Year_Of_DiagnosisPX191001020601Have you had any of the following clinician diagnosed conditions? Barrett's esophagus? If Yes, year of diagnosis4N/A
PX191001_Ulcerative_ColitisCrohns_DiseasePX191001020700Have you had any of the following clinician diagnosed conditions? Ulcerative colitis/Crohn's disease4N/A
PX191001_Ulcerative_ColitisCrohns_Year_Of_DiagnosisPX191001020701Have you had any of the following clinician diagnosed conditions? Ulcerative colitis/Crohn's disease? If Yes, year of diagnosis4N/A
PX191001_Site_Of_The_Bleeding_StomachPX191001030102What was the site of the bleeding? (Mark all that apply.) Stomach4N/A
PX191001_Site_Of_The_Bleeding_DuodenumPX191001030103What was the site of the bleeding? (Mark all that apply.) Duodenum4N/A
PX191001_Site_Of_The_Bleeding_Colon/RectumPX191001030104What was the site of the bleeding? (Mark all that apply.) Colon/Rectum4N/A
PX191001_Site_Of_The_Bleeding_OtherPX191001030105What was the site of the bleeding? (Mark all that apply.) Other4N/A
PX191001_Site_Of_The_Bleeding_UnkownPX191001030106What was the site of the bleeding? (Mark all that apply.) Unknown4N/A
PX191001_Bleeding_Year_Before_1993PX191001030201What year(s) did this happen? (Mark all that apply.) Before 19934N/A
PX191001_Bleeding_Year_1993-1997PX191001030202What year(s) did this happen? (Mark all that apply.) 1993-19974N/A
PX191001_Bleeding_Year_1998_1999PX191001030203What year(s) did this happen? (Mark all that apply.) 1998-19994N/A
PX191001_Bleeding_Year_2000_2001PX191001030204What year(s) did this happen? (Mark all that apply.) 2000-20014N/A
PX191001_Bleeding_Year_2002_2003PX191001030205What year(s) did this happen? (Mark all that apply.) 2002-20034N/A
PX191001_Bleeding_Year_2004_2005PX191001030206What year(s) did this happen? (Mark all that apply.) 2004-20054N/A
PX191001_Bleeding_Year_Before_2006+PX191001030207What year(s) did this happen? (Mark all that apply.) 2006+4N/A
PX191001_Gastrointestinal_BleedingPX191001030000Have you ever had gastrointestinal bleeding that required hospitalization or a transfusion?4N/A
PX191001_Site_Of_The_Bleeding_EsophagusPX191001030101What was the site of the bleeding? (Mark all that apply.) Esophagus4N/A