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Low faecal haemoglobin concentration potentially rules out significant colorectal disease
Author(s) -
McDonald P. J.,
Digby J.,
Innes C.,
Strachan J. A.,
Carey F. A.,
Steele R. J. C.,
Fraser C. G.
Publication year - 2013
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12087
Subject(s) - medicine , gastroenterology , colorectal cancer , endoscopy , inflammatory bowel disease , referral , adenoma , colorectal cancer screening , colonoscopy , feces , cancer , disease , paleontology , family medicine , biology
Aim The study aimed to determine whether faecal haemoglobin ( H b) concentration can assist in deciding who with lower abdominal symptoms will benefit from endoscopy. Method Faecal H b concentrations were measured on single samples from 280 patients referred for lower gastrointestinal tract endoscopy from primary care in NHS T ayside who completed a faecal immunochemical test ( FIT ) for H b and underwent subsequent endoscopy. Results Among 739 invited patients, FIT and endoscopy were completed by 280 (median age 63 (18–84) years; 59.6% women), with a median time between FIT and endoscopy of 9 days. Six (2.1%) participants had cancer, 23 (8.2%) had high‐risk adenoma ( HRA ) (more than three adenomas or any > 1 cm), 31 (11.1%) low‐risk adenoma ( LRA ) and 26 (9.3%) inflammatory bowel disease ( IBD ) as the most serious diagnosis. Those with cancer had a median faecal H b of > 1000 ng Hb/ml buffer. Those with cancer + HRA + IBD had a median faecal H b concentration of 75 ng Hb/ml buffer (95% CI 18–204), which was significantly higher than that of all remaining participants without significant colorectal disease ( P < 0.0001). Using a cut‐off faecal H b concentration of 50 ng Hb/ml buffer, negative predictive values of 100.0%, 94.4%, 93.4% and 93.9% were found for cancer, HRA , LRA and IBD . Patients with reasons for referral other than rectal bleeding and family history did not have high faecal H b concentrations. Conclusion Faecal H b concentration measurements have considerable potential to contribute to reducing unnecessary endoscopy for the majority of symptomatic patients.