Fecal occult blood
| Fecal occult blood|
WikiDoc Resources for
Fecal occult blood
Evidence Based Medicine
Guidelines / Policies / Govt
Patient Resources / Community
Healthcare Provider Resources
Continuing Medical Education (CME)
Experimental / Informatics
Synonyms and key words: Guaic positive, stool guaic
Fecal occult blood is a term for blood present in the feces that is not visibly apparent. In medicine, a fecal occult blood test is a check for hidden (occult) blood in the stool (feces). Conventional fecal occult blood tests look for heme. Newer, modern tests look for globin.
Fecal occult blood testing - as its name implies - can provide clues as to subtle blood loss in the gastrointestinal tract, anywhere from the mouth to the colon. Positive tests ("positive stool") warrant further investigation for peptic ulcers or a malignancy (such as colorectal cancer or gastric cancer).
Annual testing of a population may reduce the mortality associated with colon cancer by a third, depending on the incidence of gastrointestinal cancer in that population. It is not always cost effective to screen a large population.
If colon cancer is suspected in an individual (such as in someone with an unexplained anaemia) fecal occult blood tests are typically not warranted. If a doctor suspects colon cancer, more rigorous investigation is necessary, whether or not the test is positive.
For a simple, traditional test foods to avoid include red meat (the blood it contains can turn the test positive), radishes, turnips, cabbage, cauliflower, horseradish, uncooked broccoli, and cantaloupe (all of which contain a chemical that can turn the test positive), and citrus fruits and vitamin C supplements (which can turn the test falsely negative).
Checking for hidden (occult) blood in the stool can be done at home. Testing kits are available at pharmacies without a prescription, or a health professional may order a testing kit for use at home. If a home fecal occult blood test detects blood in the stool, a health professional should be contacted.
- (Hemoccult® or Instaccult®). This method can reduce death from colorectal cancer.
- Fecal porphyrin quantification (Hemoquant®) - high false positive rate.
- Immunochemical fecal occult blood tests (HemeSelect®), (QuickVue® iFOB) or (OC Auto 80 - Automated iFOBT®) - more specific.
- Fecal DNA test (PreGen-Plus®) is more sensitive than fecal occult blood in one study (51.6% vs. 12.9%)
One method: the test involves smearing some feces onto some absorbent paper that has been treated with a chemical. Hydrogen peroxide is dropped onto the paper; if trace amounts of blood are present, the paper will change color. This method works as hemoglobin has a peroxidase-like effect, rapidly breaking down hydrogen peroxide.
Since 2001, there are a new class of occult blood tests called Fecal Immunochemical Tests.
One test, called Insure®, is designed to address patient ease of use by using a brush, not a wooden stick, to sample stools while in the toilet bowl. Using these tests there is no direct fecal handling and there is no need for changing diet or medication to perform the test. The Clearview® iFOB test requires only one specimen, and because it is specific to human hemoglobin, patients are not required to adhere to strict dietary or medication restrictions. For hospitals and large clinics the OC Automated 80 can perform fecal occult blood detection by immunoassay. This method addresses the dietary issues associated with the guaiac test and has been shown to detect many more early stage cancers and polyps.
The common, traditional guaiac-based fecal occult blood test usually picks up a daily blood loss of about 10 ml (about two teaspoonfuls). "Normally, there is only about 0.5 to 1.5 ml of blood a day that escapes blood vessels into the stool each day. There are more sensitive tests than the guiac such as a heme-porphyrin test or an immunochemical test, but the former test is not used much due to the high false positive rate. The latter test is very sensitive -- it picks up as little as 0.3 ml... It does not detect blood from the stomach and upper small intestine so it is much more specific for bleeding from the colon or lower gastrointestinal tract."
The test is often false-positive (i.e. there is no source of bleeding). This is often due to recent ingestion of under-cooked meats, and a patient is generally advised to keep a meat-free diet for several days before handing in the feces sample.
The test is more sensitive if the sample is hydrated before testing. However, the specificity is decreased in this method.
Newer, more sophisticated assays called Fecal Immunochemical Tests have been developed to address most of the deficiencies of traditional guaiac based fecal occult blood tests.
The stool-based DNA test, PreGen-Plus® was capable of detecting several stages of colorectal cancer, in otherwise healthy adults, and most importantly in its' early stage, the easiest and most effective to treat, stage of colorectal cancer.
The DNA based PreGen-Plus®'s results were reported by the New England Journal of Medicine see their website for more.
An estimated 1-5% of the tested population have a positive fecal occult blood test. Of those, about 2-10% have cancer, while 20-30% have adenomas.
Causes for a positive test are:
- 2-10%: cancer (colorectal cancer, gastric cancer)
- 20-30% adenoma or polyps
- Bleeding peptic ulcer
- Angiodysplasia of the colon
- ↑ Diagnostic Tests — Fecal Occult Blood Test. Retrieved on 2007-07-18.
- ↑ Fecal Occult Blood Test (FOBT). Retrieved on 2007-07-18.
- ↑ Imperiale T, Ransohoff D, Itzkowitz S, Turnbull B, Ross M (2004). "Fecal DNA versus fecal occult blood for colorectal-cancer screening in an average-risk population". N Engl J Med 351 (26): 2704-14. PMID 15616205.
- ↑ What Does a Positive Fecal Occult Blood Test Mean? - B01. Retrieved on 2007-07-18.
- ↑  for the DNA based PreGen-Plus® information sheet from The New England Journal of Medicine.
Symptoms and signs: respiratory system (R04–R07, 786)
|; Respiratory sounds:
|Chest, general||* Chest pain|
Symptoms and signs: digestive system and abdomen (R10–R19, 787,789)
|Abdominal – general|
Symptoms and signs: skin and subcutaneous tissue (R20-R23, 782)
|Disturbances of skin sensation||Hypoesthesia - Paresthesia - Hyperesthesia|
|Other||Rash - Cyanosis - Pallor - Flushing - Petechia - Desquamation - Induration - Diaphoresis|
Symptoms and signs: nervous and musculoskeletal systems (R25-R29, 781)
|Abnormal involuntary movements|
(see also movement disorders)
|Tremor - Spasm - Fasciculation - Athetosis|
|Gait abnormality||Scissor gait - Antalgic gait - Cerebellar ataxia - Festinating gait - Pigeon gait - Propulsive gait - Steppage gait - Stomping gait - Spastic gait - Myopathic gait - Magnetic gait - Trendelenburg gait|
|Lack of coordination||Ataxia (Cerebellar ataxia, Sensory ataxia) - Dysmetria - Dysdiadochokinesia - Hypotonia|
|Other||Tetany - Meningism - Hyperreflexia - Opisthotonus - Abnormal posturing - Hemispatial neglect|
Symptoms and signs: urinary system (R30-R39, 788)
|General||Renal colic - Dysuria - Vesical tenesmus - Urinary incontinence - Urinary retention - Oliguria - Polyuria - Nocturia - Extravasation of urine - Extrarenal uremia|
Symptoms and signs: cognition, perception, emotional state and behaviour (R40-R46, 780-781)
|General||Anxiety - Somnolence - Coma - Amnesia (Anterograde amnesia, Retrograde amnesia) - Dizziness/Vertigo|
|Olfaction||Anosmia - Parosmia|
|Taste||Ageusia - Parageusia|
Symptoms and signs: Speech and voice (R47-R49, 784)
|Aphasia/Dysphasia||Expressive aphasia - Receptive aphasia - Conduction aphasia|
|Other speech disturbances||Dysarthria - Schizophasia|
|Symbolic dysfunctions||Dyslexia - Alexia - Agnosia (Prosopagnosia) - Apraxia - Acalculia - Agraphia|
|Voice disturbances||Dysphonia - Aphonia|
Symptoms and signs: general (R50-R69, 780-789)
|General||Fever (Hyperpyrexia) - Headache - Chronic pain - Malaise/Fatigue (Asthenia, Debility) - Fainting (Vasovagal syncope) - Febrile seizure - Shock (Cardiogenic shock) - Lymphadenopathy - Edema (Peripheral edema, Anasarca) - Hyperhidrosis (Sleep hyperhidrosis) - Delayed milestone - Failure to thrive - Short stature (Idiopathic) - food and fluid intake (Anorexia, Polydipsia, Polyphagia) - Cachexia - Xerostomia - Clubbing - Tenderness|
Symptoms and signs: Symptoms concerning nutrition, metabolism and development (R62–R64, 783)
|Growth||Delayed milestone • Failure to thrive • Short stature (e.g., Idiopathic)|
There is no pharmaceutical or device industry support for this site and we need your viewer supported Donations | Editorial Board | Governance | Licensing | Disclaimers | Avoid Plagiarism | Policies