Abstract
Fecal occult blood test is the most widely used screening test for diagnosis of gastrointestinal bleeding disorders specially colorectal carcinoma. Among the various methods of fecal occult blood tests, chemical method is being used commonly, but the method has some drawbacks like low participation rate, high false positive rate, low sensitivity etc. To overcome these short comings, newer immunological method was introduced. This study evaluated the role of immunological method of fecal blood test in the diagnosis of occult lower GIT bleeding. Stool samples from two hundred patients were examined by both chemical and immunological method. The patients who were positive by any or both methods of occult blood test, were advised for colonoscopy. During colonoscopy tissues were taken for histopathology which was the gold standard of this study. Among 110 OBT positive patients pathological lesions were detected in 65 patients by colonoscopy and histopathology. The diseases detected by colonoscopy and histopathology 18 colorectal polyp, 8 colorectal cancer, 24 ulcerative lesions and 5 inflammatory bowel disease etc. Regarding comparative analysis of chemical and immunological method, the higher sensitivity (95.4% vs. 49.2%), specificity (44.4% vs. 37.8%), accuracy (74.5% vs. 44.5%), PPV (71.3% vs. 53.3%) and NPV (87% vs. 34%) of immunological method than chemical method was observed. Thus immunological method of fecal occult blood test was appeared to be a better alternative to conventional chemical method of fecal occult blood test in the diagnosis of occult lower GIT bleeding.
Highlights
Gastro intestinal bleeding disorders specially colorectal diseases are major public health issue worldwide
Result from this study showed that immunological method has high participation rate and higher validity and reliability than chemical method
A simplified sampling process and reduction in number of required samples are associated with increases participation[10]. This may indicate a preference for immunological method which has no dietary restrictions and are often designed to be more user friendly[11]
Summary
Gastro intestinal bleeding disorders specially colorectal diseases are major public health issue worldwide. The diseases causing occult blood in stools include intestinal polyps (>1cm), diverticular bleeding, ischemic colitis, anal fissure, internal hemorrhoids, infections such as amoebiasis, ascariasis, hookworm, tuberculosis, colon cancer, lymphoma, inflammatory bowel diseases etc[2] Among these conditions, colorectal cancer is the most important because of high incidence and mortality rate[3]. The methods commonly used to diagnose GIT bleeding disorders are colonoscopy, flexible sigmoidoscopy, CT colonography and virtual colonoscopy, barium enema, fecal occult blood test and detection of human DNA in stool[4]. Among these tests colonoscopy remains the gold standard for visualization, biopsy and removal of colonic polyps[5]. To reduce the incidence and mortality from GIT bleeding disorders by early diagnosis and further management of the patient
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