Fecal Blood Levels in Health and Disease

Ahlquist, David A.; McGill, Douglas B.; Schwartz, Samuel; Taylor, William F.; Owen, Richard

doi:10.1056/nejm198505303122204

Cited by 170 publications

(57 citation statements)

References 35 publications

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“…In accordance with our results, several authors have observed that the sensitivity of the G-FOBT decreases as the amount of bleeding of the lesion increases (Morris et al, 1976;Stroehlein et al, 1976;Herzog et al, 1982;Ahlquist et al, 1985;Macrae and St John, 1987). As in other studies, in our population, the measured intensity of bleeding of invasive cancers was higher than that of high-risk adenomas (Levi et al, 2007;Ciatto et al, 2007).…”

Section: Discussionsupporting

confidence: 92%

Comparison of a guaiac and an immunochemical faecal occult blood test for the detection of colonic lesions according to lesion type and location

Guittet

Bouvier

Mariotte³

et al. 2009

Br J Cancer

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We investigated variations in sensitivity of an immunochemical (I-FOBT) and a guaiac (G-FOBT) faecal occult blood test according to type and location of lesions in an average-risk 50-to 74-year-old population. Screening for colorectal cancer by both non-rehydrated Haemoccult II G-FOBT and Magstream I-FOBT was proposed to a sample of 20 322 subjects. Of the 1615 subjects with at least one positive test, colonoscopy results were available for 1277. A total of 43 invasive cancers and 270 high-risk adenomas were detected. The gain in sensitivity associated with the I-FOBT was calculated using the ratio of sensitivities (RSN) according to type and location of lesions, and amount of bleeding. The gain in sensitivity by using I-FOBT increased from invasive cancers (RSN ¼ 1.48 (1.16 -4.59)) to high-risk adenomas (RSN ¼ 3.32 (2.70 -4.07)), and was inversely related to the amount of bleeding. Among cancers, the gain in sensitivity was confined to rectal cancer (RSN ¼ 2.09 (1.36 -3.20)) and concerned good prognosis cancers, because they involve less bleeding. Among high-risk adenomas, the gain in sensitivity was similar whatever the location. This study suggests that the gain in sensitivity by using an I-FOBT instead of a G-FOBT greatly depends on the location of lesions and the amount of bleeding. Concerning cancer, the gain seems to be confined to rectal cancer.

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Section: Discussionsupporting

confidence: 92%

Comparison of a guaiac and an immunochemical faecal occult blood test for the detection of colonic lesions according to lesion type and location

Guittet

Bouvier

Mariotte³

et al. 2009

Br J Cancer

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“…An assay kit for faecal haemoglobin based upon the overall analysis of porphyrins is available (HemoQuant) (Ahlquist et al, 1985) but its capability to detect nonsteroidal induced gastrointestinal blood loss has not been evaluated. Additionally the less selective assay would make it more sensitive to artefacts.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal blood loss after non‐steroidal anti‐inflammatory drugs. Measurement by selective determination of faecal porphyrins.

Cohen

Boeijinga

Haard

et al. 1992

Brit J Clinical Pharma

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1. A method for the detection of gastrointestinal blood loss based upon the selective measurement of faecal porphyrins was tested in two studies in healthy volunteers. 2. In the first study subjects (n = 6) received intragastric autologous blood (saline, 2 and 6 ml as a single dose) resulting in a dose dependent increase in faecal porphyrins. 3. In a subsequent placebo controlled cross over study in 12 subjects acetylsalicylic acid (ASA), nabumetone (a new NSAID) or placebo were administered for 5 days with a washout period of 9 days. They were no dietary restrictions. 4. All faeces were collected during the treatment period and both the full faecal homogenate and a random faecal sample were analyzed for deutero‐ and pemptoporphyrin content by h.p.l.c. Additionally a benzidine reaction was performed. 5. There was a highly significant correlation (r = 0.95) between the values obtained from random samples and the full homogenate. ASA increased the faecal porphyrin excretion (P less than 0.001) compared with placebo in contrast to nabumetone. Complaints of dyspepsia were most common after ASA. 6. Measurement of faecal porphyrins is useful for monitoring NSAID induced upper gastrointestinal blood loss and lacks some of the practical constraints of other methods.

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“…A further study in healthy volunteers (mean age 30 years), however, demonstrated no FOB loss detectable by guaiac-based FOB testing in individuals taking up to 325 mg daily for 30 days [16]. It is also known that FOB testing is a poor indicator of significant upper gastrointestinal pathology and previous studies suggest that it is unnecessary for patients with a positive FOB test to undergo upper gastrointestinal investigations unless they have upper gastrointestinal symptoms [17,18]. …”

Section: Discussionmentioning

confidence: 99%

Aspirin Users Attending for NHS Bowel Cancer Screening Have Less Colorectal Neoplasia: Chemoprevention or False-Positive Faecal Occult Blood Testing?

Lee¹,

Hull²,

Rajasekhar³

et al. 2012

Digestion

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Objective: The NHS Bowel Cancer Screening Programme (BCSP) uses faecal occult blood (FOB) testing to select patients aged 60–69 years for colonoscopy. Aim: To examine the association between aspirin use and the detection of colorectal neoplasia in screened patients undergoing colonoscopy. Methods: Data were collected prospectively on individuals who underwent colonoscopy following a positive FOB test in the South of Tyne area between February 2007 and 2009. The relationship between the presence of colorectal neoplasia and age, gender, body mass index (BMI) and current aspirin use were evaluated using logistic regression analysis. Results: 701 individuals underwent colonoscopy. 414 (59.1%) were male and 358 (51.1%) aged over 65 years. Males had a higher incidence of colorectal neoplasia (relative risk 2.26, 95% CI 1.65–3.10, p < 0.001). Current aspirin use was associated with a lower neoplasia detection rate (relative risk 0.79, 95% CI 0.50–0.98, p = 0.039). Increased age and BMI were not significantly associated with higher neoplasia detection. Conclusion: Amongst individuals undergoing colonoscopy following a positive FOB test in the BCSP, current aspirin use was associated with a lower incidence of colorectal neoplasia. This may represent the chemopreventative effect of aspirin or increased false positivity of FOB testing. Further work is needed to clarify the contribution of each and could reduce the number of unnecessary colonoscopies.

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Fecal Blood Levels in Health and Disease

Cited by 170 publications

References 35 publications

Comparison of a guaiac and an immunochemical faecal occult blood test for the detection of colonic lesions according to lesion type and location

Comparison of a guaiac and an immunochemical faecal occult blood test for the detection of colonic lesions according to lesion type and location

Gastrointestinal blood loss after non‐steroidal anti‐inflammatory drugs. Measurement by selective determination of faecal porphyrins.

Aspirin Users Attending for NHS Bowel Cancer Screening Have Less Colorectal Neoplasia: Chemoprevention or False-Positive Faecal Occult Blood Testing?

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