Performance of the immunochemical fecal occult blood test in predicting lesions in the lower gastrointestinal tract

Tsung-Hsien Chiang; Yi-Chia Lee; Chia-Hung Tu; Han-Mo Chiu; Ming-Shiang Wu
September 2011
CMAJ: Canadian Medical Association Journal;9/20/2011, Vol. 183 Issue 13, p1474
Academic Journal
Background: Previous studies have suggested that the immunochemical fecal occult blood test has superior specificity for detecting bleeding in the lower gastrointestinal tract even if bleeding occurs in the upper tract. We conducted a large population-based study involving asymptomatic adults in Taiwan, a population with prevalent upper gastrointestinal lesions, to confirm this claim. Methods: We conducted a prospective cohort study involving asymptomatic people aged 18 years or more in Taiwan recruited to undergo an immunochemical fecal occult blood test, colonoscopy and esophagogastroduodenoscopy between August 2007 and July 2009. We compared the prevalence of lesions in the lower and upper gastrointestinal tracts between patients with positive and negative fecal test results. We also identified risk factors associated with a false-positive fecal test result. Results: Of the 2796 participants, 397 (14.2%) had a positive fecal test result. The sensitivity of the test for predicting lesions in the lower gastrointestinal tract was 24.3%, the specificity 89.0%, the positive predictive value 41.3%, the negative predictive value 78.7%, the positive likelihood ratio 2.22, the negative likelihood ratio 0.85 and the accuracy 73.4%. The prevalence of lesions in the lower gastrointestinal tract was higher among those with a positive fecal test result than among those with a negative result (41.3% v. 21.3%, p < 0.001). The prevalence of lesions in the upper gastrointestinal tract did not differ significantly between the two groups (20.7% v. 17.5%, p = 0.12). Almost all of the participants found to have colon cancer (27/28, 96.4%) had a positive fecal test result; in contrast, none of the three found to have esophageal or gastric cancer had a positive fecal test result (p < 0.001). Among those with a negative finding on colonoscopy, the risk factors associated with a false-positive fecal test result were use of anti platelet drugs (adjusted odds ratio [OR] 2.46, 95% confidence interval [CI] 1.21-4.98) and a low hemoglobin concentration (adjusted OR 2.65, 95% CI 1.62-4.33). Interpretation: The immunochemical fecal occult blood test was specific for predicting lesions in the lower gastro intestinal tract. However, the test did not adequately predict lesions in the upper gastrointestinal tract.


Related Articles

  • Fecal occult blood test in patients on low-dose aspirin, warfarin, clopidogrel, or non-steroidal anti-inflammatory drugs. Sawhney, Mandeep S.; McDougall, Heather; Nelson, Douglas B.; Bond, John H. // Digestive Diseases & Sciences;Jun2010, Vol. 55 Issue 6, p1637 

    Aim: To determine the effect of anticoagulants and antiplatelet medications on the positive-predictive-value of fecal occult blood test (FOBT).Methods: All patients who underwent a colonoscopy at our institution from 1995 to 2006 for a positive FOBT were identified....

  • Discrepancy in results from three guaiacum resin tests. Feneyrou, B.; Bories, P.; Pomier-Layrargues, G.; Michael, H.; Gravagne, G. // British Medical Journal (Clinical Research Edition);1/23/1982, Vol. 284 Issue 6311, p235 

    Compares the results obtained with HemoFEC, Haemoccult II, and Fecatest for the detection of occult blood in the feces. Investigation of the effectiveness of the products; Examination of the entire colon by rectocolonoscopy; Discrepancy in the results obtained.

  • Performance Characteristics and Comparison of Two Fecal Occult Blood Tests in Patients Undergoing Colonoscopy. Kathleen Schultz; Sanjay Jagannath; Mary Harris; Sergey Kantsevoy; Marshall Bedine; Anthony Kalloo // Digestive Diseases & Sciences;Apr2007, Vol. 52 Issue 4, p1009 

    Abstract  We investigated the use of a new type of FOBT (EZ-Detect) that uses the blood's pseudo-peroxidase activity as an enzymatic catalyst, in a one-step chromogen-substrate system performed by the patient. Asymptomatic patients ≥50 years old received three Hemoccult II (HO) cards...

  • A schwannoma of the cecum: Case report and review of Japanese schwannomas in the large intestine. Tomozawa, Shigeru; Masaki, Tadahiko; Matsuda, Keiji; Yokoyama, Tadashi; Ishida, Tsuyoshi; Muto, Tetsuichiro // Journal of Gastroenterology;1998, Vol. 33 Issue 6, p872 

    Abstract: A 66-year-old Japanese man had a positive fecal occult blood test at a regular check-up, and a large polypoid mass was detected in the cecum by barium enema study. Colonoscopy showed a submucosal tumor with ulcer protruding into the cecal lumen. A large forceps biopsy specimen was...

  • Fecal immunochemical test good alternative when colonoscopy capacity limited. Ko, Andrew H. // Hem/Onc Today;12/10/2011, Vol. 12 Issue 23, p21 

    The article discusses research study being done on fecal immunochemical test as an alternative to colonoscopy, referencing a study by J. A. Wilschut et al., published in a 2011 issue of the "Journal of the National Cancer Institute."

  • Intramucosal adenocarcinoma of the ileum originated 40 years after ileosigmoidostomy. Sameshima, Shinichi; Tomozawa, Shigeru; Koketsu, Shinichiro; Okada, Toshiyuki; Miyato, Hideyo; Iijima, Misa; Kojima, Masaru; Kaji, Toshio // World Journal of Surgical Oncology;2009, Vol. 7, p1 

    Background: Small bowel adenocarcinomas (SBAs) are rare carcinomas. They are asymptomatic and usually neither endoscopy nor contrast studies are performed for screening Case presentation: A 72-year-old Japanese male had a positive fecal occult blood test at a regular check-up in 2006. He...

  • Direct to colonoscopy may be more efficient than annual fecal tests.  // Modern Medicine;Oct94, Vol. 62 Issue 10, p60 

    Presents a summary of the article `Fecal Occult Blood Screening for Colorectal Cancer,' by C.A. Land and D.F. Ransohoff, from `JAMA' dated April 6, 1994. Development of a mathematical model to represent the clinical course of a hypothetical group of people participating in a 15-year fecal...

  • DNA test beats Hemoccult.  // Cortlandt Forum;3/25/2005, Vol. 18 Issue 3, p16 

    This article focuses on a study which shows that fecal DNA testing detects fewer colorectal neoplasms than had been reported earlier, but it still is nearly twice as sensitive as testing for occult blood. In a related study, conventional colonoscopy proved superior to virtual colonoscopy by a...

  • Screening for Colorectal Cancer. Eddy, David M. // Annals of Internal Medicine;9/1/90, Vol. 113 Issue 5, p373 

    Discusses the significance of screening in reducing colorectal cancer mortality. Probability of developing colorectal cancer; Description of various screening tests such as colonoscopy and fecal occult blood test; Main risks associated with using the tests.


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics