Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK.
Department of Blood Sciences, Ninewells Hospital and Medical School, Dundee, Scotland, UK.
Ann Clin Biochem. 2020 Jul;57(4):325-327. doi: 10.1177/0004563220935622.
Current guidelines document persistent rectal bleeding as an alarm symptom in patients presenting to primary care. We studied whether a faecal immunochemical test could assist in their assessment.
From December 2015, faecal immunochemical tests were routinely available to primary care when assessing patients with new-onset bowel symptoms: general practitioners were encouraged to include faecal haemoglobin concentration (f-Hb) within any referral to secondary care. Results with f-Hb ≥10 g Hb/g faeces were defined as positive. The incidence of significant bowel disease (SBD: colorectal cancer [CRC], higher-risk adenoma [HRA: any ≥1 cm, or three or more] and inflammatory bowel disease [IBD]) at subsequent colonoscopy, referred symptoms and f-Hb were recorded.
Of 1447 patients with a faecal immunochemical test result and colonoscopy outcome, SBD was diagnosed in 296 patients (20.5%; 95 with CRC, 133 with HRA, and 68 with IBD). Four hundred and sixty-two patients (31.9%) reported rectal bleeding: 294 had f-Hb ≥10 g Hb/g faeces. At colonoscopy, 105/294 had SBD versus 14/168 with rectal bleeding and f-Hb <10 g Hb/g faeces ( < 0.0001), comprising one case of CRC (0.6%), 12 HRA (7.1%) and one new case of IBD (0.6%); further, the single cancer and 8 of the 12 HRA were located in the descending colon.
Patients with rectal bleeding and f-Hb <10 g Hb/g faeces are unlikely to have SBD and could be investigated by sigmoidoscopy alone. Using the faecal immunochemical test to guide investigation of patients with rectal bleeding is a rational and practical way forward.
目前的指南文件记录了直肠出血是患者在初级保健就诊时的警报症状。我们研究了粪便免疫化学测试是否可以协助评估。
从 2015 年 12 月开始，在评估出现新发性肠症状的患者时，常规提供粪便免疫化学测试给初级保健医生：鼓励全科医生将粪便血红蛋白浓度（f-Hb）纳入任何向二级保健的转诊中。f-Hb≥10gHb/g 粪便的结果定义为阳性。随后结肠镜检查中发现的显著肠道疾病（SBD：结直肠癌[CRC]、高危腺瘤[HRA：任何≥1cm，或≥3 个]和炎症性肠病[IBD]）、转诊症状和 f-Hb 均被记录下来。
在 1447 例有粪便免疫化学测试结果和结肠镜检查结果的患者中，诊断出 SBD 患者 296 例（20.5%；95 例 CRC，133 例 HRA，68 例 IBD）。462 例（31.9%）患者报告有直肠出血：294 例 f-Hb≥10gHb/g 粪便。在结肠镜检查中，105/294 例患者有 SBD，而 14/168 例有直肠出血和 f-Hb<10gHb/g 粪便的患者有 SBD（ < 0.0001），其中包括 1 例 CRC（0.6%）、12 例 HRA（7.1%）和 1 例新的 IBD（0.6%）；此外，单一癌症和 12 例 HRA 中的 8 例位于降结肠。
有直肠出血和 f-Hb<10gHb/g 粪便的患者不太可能患有 SBD，可以单独进行乙状结肠镜检查进行调查。使用粪便免疫化学测试来指导有直肠出血的患者的检查是一种合理且实用的方法。
