Faecal immunochemical tests (FIT) in the assessment of patients presenting with lower bowel symptoms: Concepts and challenges

Callum G. Fraser (Lead / Corresponding author)

    Research output: Contribution to journalReview article

    5 Citations (Scopus)

    Abstract

    Colonoscopy is a relatively scarce resource in many countries, including Scotland, and a simple investigation which would aid general practitioners in particular in decision-making as to which patients presenting with lower bowel symptoms warranted referral would be of much help. Faecal immunochemical tests for haemoglobin (FIT) have many advantageous characteristics and are now proven to be of considerable value in the timely assessment of patients with symptoms of lower bowel disease. Quantitative FIT provide numerical estimates of faecal haemoglobin concentration (f-Hb) and, at low f-Hb cut-off, FIT have high sensitivity for colorectal cancer (CRC) and could be used as a rule-in test to stimulate rapid referral, especially when symptoms are suggestive of serious bowel disease. Perhaps more importantly, a low f-Hb gives considerable reassurance that significant bowel disease (CRC + higher-risk adenoma + inflammatory bowel disease) is absent and further investigation may not be warranted: however, no test is perfect, so some cases will remain undetected using FIT alone and robust safety netting is required, possibly including watching and waiting, referral to clinics in secondary care, or a repeat FIT. Moreover, the FIT results should not be taken in isolation, but clinical impressions and the results of other investigations, probably including the full blood count, should be considered. Challenges still exist, however, and harmonisation of aspects of the available FIT analytical systems is required. Moreover, a number of seemingly valid clinical concerns remain and these require resolution through further research and reporting of studies done in real clinical practice.

    Original languageEnglish
    Pages (from-to)302-308
    Number of pages7
    JournalSurgeon
    Volume16
    Issue number5
    DOIs
    Publication statusPublished - 1 Oct 2018

    Fingerprint

    Hemoglobins
    Referral and Consultation
    Colorectal Neoplasms
    Secondary Care
    Scotland
    Colonoscopy
    Inflammatory Bowel Diseases
    Adenoma
    General Practitioners
    Decision Making
    Safety
    Research

    Keywords

    • Bowel disease
    • Colorectal cancer
    • Faecal haemoglobin
    • Faecal immunochemical test
    • Faecal occult blood test
    • Inflammatory bowel disease
    • Inflammatory Bowel Diseases/diagnosis
    • Hemoglobins/analysis
    • Immunologic Tests
    • Early Detection of Cancer
    • Humans
    • Colorectal Neoplasms/diagnosis
    • Mass Screening
    • Sensitivity and Specificity
    • Feces/chemistry
    • Occult Blood

    Cite this

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    title = "Faecal immunochemical tests (FIT) in the assessment of patients presenting with lower bowel symptoms: Concepts and challenges",
    abstract = "Colonoscopy is a relatively scarce resource in many countries, including Scotland, and a simple investigation which would aid general practitioners in particular in decision-making as to which patients presenting with lower bowel symptoms warranted referral would be of much help. Faecal immunochemical tests for haemoglobin (FIT) have many advantageous characteristics and are now proven to be of considerable value in the timely assessment of patients with symptoms of lower bowel disease. Quantitative FIT provide numerical estimates of faecal haemoglobin concentration (f-Hb) and, at low f-Hb cut-off, FIT have high sensitivity for colorectal cancer (CRC) and could be used as a rule-in test to stimulate rapid referral, especially when symptoms are suggestive of serious bowel disease. Perhaps more importantly, a low f-Hb gives considerable reassurance that significant bowel disease (CRC + higher-risk adenoma + inflammatory bowel disease) is absent and further investigation may not be warranted: however, no test is perfect, so some cases will remain undetected using FIT alone and robust safety netting is required, possibly including watching and waiting, referral to clinics in secondary care, or a repeat FIT. Moreover, the FIT results should not be taken in isolation, but clinical impressions and the results of other investigations, probably including the full blood count, should be considered. Challenges still exist, however, and harmonisation of aspects of the available FIT analytical systems is required. Moreover, a number of seemingly valid clinical concerns remain and these require resolution through further research and reporting of studies done in real clinical practice.",
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    Faecal immunochemical tests (FIT) in the assessment of patients presenting with lower bowel symptoms : Concepts and challenges. / Fraser, Callum G. (Lead / Corresponding author).

    In: Surgeon, Vol. 16, No. 5, 01.10.2018, p. 302-308.

    Research output: Contribution to journalReview article

    TY - JOUR

    T1 - Faecal immunochemical tests (FIT) in the assessment of patients presenting with lower bowel symptoms

    T2 - Concepts and challenges

    AU - Fraser, Callum G.

    N1 - This work had no financial support.

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    Y1 - 2018/10/1

    N2 - Colonoscopy is a relatively scarce resource in many countries, including Scotland, and a simple investigation which would aid general practitioners in particular in decision-making as to which patients presenting with lower bowel symptoms warranted referral would be of much help. Faecal immunochemical tests for haemoglobin (FIT) have many advantageous characteristics and are now proven to be of considerable value in the timely assessment of patients with symptoms of lower bowel disease. Quantitative FIT provide numerical estimates of faecal haemoglobin concentration (f-Hb) and, at low f-Hb cut-off, FIT have high sensitivity for colorectal cancer (CRC) and could be used as a rule-in test to stimulate rapid referral, especially when symptoms are suggestive of serious bowel disease. Perhaps more importantly, a low f-Hb gives considerable reassurance that significant bowel disease (CRC + higher-risk adenoma + inflammatory bowel disease) is absent and further investigation may not be warranted: however, no test is perfect, so some cases will remain undetected using FIT alone and robust safety netting is required, possibly including watching and waiting, referral to clinics in secondary care, or a repeat FIT. Moreover, the FIT results should not be taken in isolation, but clinical impressions and the results of other investigations, probably including the full blood count, should be considered. Challenges still exist, however, and harmonisation of aspects of the available FIT analytical systems is required. Moreover, a number of seemingly valid clinical concerns remain and these require resolution through further research and reporting of studies done in real clinical practice.

    AB - Colonoscopy is a relatively scarce resource in many countries, including Scotland, and a simple investigation which would aid general practitioners in particular in decision-making as to which patients presenting with lower bowel symptoms warranted referral would be of much help. Faecal immunochemical tests for haemoglobin (FIT) have many advantageous characteristics and are now proven to be of considerable value in the timely assessment of patients with symptoms of lower bowel disease. Quantitative FIT provide numerical estimates of faecal haemoglobin concentration (f-Hb) and, at low f-Hb cut-off, FIT have high sensitivity for colorectal cancer (CRC) and could be used as a rule-in test to stimulate rapid referral, especially when symptoms are suggestive of serious bowel disease. Perhaps more importantly, a low f-Hb gives considerable reassurance that significant bowel disease (CRC + higher-risk adenoma + inflammatory bowel disease) is absent and further investigation may not be warranted: however, no test is perfect, so some cases will remain undetected using FIT alone and robust safety netting is required, possibly including watching and waiting, referral to clinics in secondary care, or a repeat FIT. Moreover, the FIT results should not be taken in isolation, but clinical impressions and the results of other investigations, probably including the full blood count, should be considered. Challenges still exist, however, and harmonisation of aspects of the available FIT analytical systems is required. Moreover, a number of seemingly valid clinical concerns remain and these require resolution through further research and reporting of studies done in real clinical practice.

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    KW - Faecal immunochemical test

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    KW - Inflammatory bowel disease

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    KW - Hemoglobins/analysis

    KW - Immunologic Tests

    KW - Early Detection of Cancer

    KW - Humans

    KW - Colorectal Neoplasms/diagnosis

    KW - Mass Screening

    KW - Sensitivity and Specificity

    KW - Feces/chemistry

    KW - Occult Blood

    U2 - 10.1016/j.surge.2018.01.004

    DO - 10.1016/j.surge.2018.01.004

    M3 - Review article

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    AN - SCOPUS:85043456628

    VL - 16

    SP - 302

    EP - 308

    JO - Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

    JF - Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland

    SN - 1479-666X

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    ER -