Relative Frequency of Upper Gastrointestinal and Colonic Lesions in Patients with Positive Fecal Occult-Blood Tests

Rockey, Don C.; Koch, Johannes; Cello, John P.; Sanders, Linda; McQuaid, Kenneth R.

doi:10.1056/nejm199807163390303

Cited by 154 publications

(50 citation statements)

References 33 publications

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“…Furthermore the frequency of inflammatory GI lesions such as gastritis and esophagitis was more prevalent than GI ulcers and tumor lesions. In addition, GI lesions as a source of IDA were more frequently located in the upper GI tract than in the colon, a finding in agreement with previously reported studies [13][14][15][16][17].…”

Section: Discussionsupporting

confidence: 93%

Gastrointestinal Lesions in African American Patients with Iron Deficiency Anemia

Ashktorab¹

2017

Gastrointest Cancer Res Ther

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Background: Iron deficiency anemia (IDA) is a frequent disorder that is associated with many serious diseases. However, the findings of an evaluation of IDA associated gastrointestinal disorders are lacking among African American patients. Aim:To determine the most prevalent gastrointestinal lesions among African American patients with IDA especially in young men. Methods:We reviewed medical records (n=422) of patients referred for evaluation of IDA from 2008 to 2012. IDA was diagnosed using clinical laboratory tests. The results of esophagogastroduodenoscopy (EGD), colonoscopy and pathology specimens along with demographic data were abstracted and analyzed using STATA. Results:The mean age was 61.9 years, and 50.5% were female. 189 patients (45%) had gross GI bleeding. The most frequent diagnoses were gastritis (40%), benign colonic lesions (13%), esophagitis (9%), gastric ulcer (6%), and duodenitis (6%). By sex, duodenal benign tumors were significantly more represented among females: 4% vs 1% (p=0.05) while left colon malignancy was more prevalent among males: 3% vs 0.05% (p=0.05). Benign and malignant colonic lesions were significantly more present among older patients: 16% vs 6% (P=0.005) and 5% vs 0% (p=0.008), respectively. Colitis was more prevalent in younger patients (≤50): 11% vs 2% (p=0.001). In patients with gross lower GI bleeding, the top diagnoses were gastritis (25%), benign colon tumors (10%), and duodenitis (6%). Colon cancer was diagnosed among 15 patients and all these patients were older than 50 years of age. Conclusion:This exploratory analysis of IDA associated GI lesions revealed that gastritis and colonic lesions are most common lesions found among African Americans with IDA with minimal age and sex differences. Colitis was found more in young patients while IDA was more associated with lower GI malignancies in older patients. Upper GI endoscopy might be required if colonoscopy is unrevealing of the cause of IDA.

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Section: Discussionsupporting

confidence: 93%

Gastrointestinal Lesions in African American Patients with Iron Deficiency Anemia

Ashktorab¹

2017

Gastrointest Cancer Res Ther

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“…6,7 Studies reviewing causes for FOBt positivity outside of a formal screening programme have reported a wide variation in NNF of 5-45%. 8,9 This variation may be due to methods of reporting. Diverticular disease and haemorrhoids are variably reported, with some studies suggesting that these findings would not cause FOBt positivity.…”

Section: Introductionmentioning

confidence: 99%

Non-neoplastic findings at colonoscopy after positive faecal occult blood testing: Data from the English Bowel Cancer Screening Programme

Bevan¹,

Lee²,

Nickerson

et al. 2014

J Med Screen

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Background: The aim of the English Bowel Cancer Screening Programme (BCSP) is to diagnose early colorectal cancer and advanced adenomas. However, other findings are also reported at screening colonoscopy. Small studies demonstrate findings other than cancer or adenomas (non-neoplastic findings (NNF)) in 11-25%. Objectives and setting: Describe the frequency and nature of NNF within the BSCP. Methods: Data were obtained from the BCSP national database for all individuals undergoing colonoscopic investigation after positive faecal occult blood testing between August 2006 and November 2011. Data included demographics, smoking status, neoplastic findings and NNF. Results: 121728 colonoscopies were analysed. 51 NNF were found in 26251 cases (21.6%). Diverticular disease (18875 cases) and haemorrhoids (7011) were the most frequently reported. Inflammatory bowel disease (IBD) was reported in 2152 cases. Individuals with a neoplastic diagnosis were less likely to have an NNF than those without (19.8% v 24.4%, p < 0.001). After adjustment for confounding using multivariable analysis, older age was still associated with a small but statistically significant risk of NNF. Conclusions: The BCSP generates a significant volume of NNF. A small proportion of individuals were found to have inflammatory bowel disease (IBD) -an important diagnosis with implications for long-term management. BCSP participants should be aware that findings other than neoplasia may be detected and the relevance of these findings to that individual is not known. Reporting of NNF varies between colonoscopists, and potential underreporting is a limitation of this study. Further study is required to establish the impact of NNF on primary and secondary care.

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“…Previous studies showed that the frequency of lesions in the upper gastrointestinal tract was comparable or even higher than that of colonic lesions [5][6][7][8][9] and that the use of esophagogastroduodenoscopy may change clinical management. 10,11 Some studies showed that evaluation of the upper gastrointestinal tract helped to identify important lesions in symptomatic patients and those with iron deficiency anemia; 12,13 however, others concluded that esophagogastroduodenos copy was unjustified because important findings in the upper gastrointestinal tract were rare [14][15][16][17] and sometimes irrelevant to the results of fecal occult blood testing.…”

mentioning

confidence: 99%

“…10,11 Some studies showed that evaluation of the upper gastrointestinal tract helped to identify important lesions in symptomatic patients and those with iron deficiency anemia; 12,13 however, others concluded that esophagogastroduodenos copy was unjustified because important findings in the upper gastrointestinal tract were rare [14][15][16][17] and sometimes irrelevant to the results of fecal occult blood testing. [18][19][20][21] This controversy is re lated to the heterogeneity of study populations and to the limitations of the formerly used guaiac-based fecal occult blood test, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] which was not able to distinguish bleeding in the lower gastrointestinal tract from that originating in the upper tract.…”

mentioning

confidence: 99%

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

Chiang¹,

Lee²,

Tu³

et al. 2011

Canadian Medical Association Journal

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Relative Frequency of Upper Gastrointestinal and Colonic Lesions in Patients with Positive Fecal Occult-Blood Tests

Abstract: In a group of patients with positive fecal occult-blood tests who were referred for further evaluation, from which those with iron-deficiency anemia and active bleeding had been excluded, upper gastrointestinal lesions were identified more frequently than colonic lesions.

Cited by 154 publications

References 33 publications

Gastrointestinal Lesions in African American Patients with Iron Deficiency Anemia

Gastrointestinal Lesions in African American Patients with Iron Deficiency Anemia

Non-neoplastic findings at colonoscopy after positive faecal occult blood testing: Data from the English Bowel Cancer Screening Programme

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

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