Do other variables add value to assessment of the risk of colorectal disease using faecal immunochemical tests for haemoglobin?

Jayne Digby (Lead / Corresponding author), Bob Steele, Judith A. Strachan, Craig Mowat, Annie Anderson, Rebecca McCann, Louise Law, Callum Fraser

Research output: Contribution to journalArticle

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Abstract

Background: Faecal immunochemical tests for haemoglobin have been recommended to assist in assessment of patients presenting in primary care with lower bowel symptoms. The aim was to assess if, and which, additional variables might enhance this use of faecal immunochemical tests.

Methods: Faecal immunochemical test analysis has been a NHS Tayside investigation since December 2015. During the first year, 993 patients attending colonoscopy were invited to complete a detailed questionnaire on demographic background, symptoms, smoking status, alcohol use, dietary fibre, red and processed meat intake, physical activity, sitting time, dietary supplement use, family history of colorectal cancer, adenoma, inflammatory bowel disease and diabetes. Significant bowel disease was classified as colorectal cancer, advanced adenoma or inflammatory bowel disease.

Results: A total of 470 (47.3%) invitees agreed to complete the questionnaire and 408 (41.1%) did. Unadjusted odds ratios for the presence of significant bowel disease compared with undetectable faecal haemoglobin increased with increasing faecal haemoglobin and for faecal haemoglobin 10–49, 50–199, 200–399 and ⩾400 μg Hb/g faeces were 0.95 (95% CI: 0.16–5.63), 2.47 (0.55–1.03), 6.30 (1.08–36.65) and 18.90 (4.22–84.62), respectively. Rectal bleeding and family history of polyps were the only other variables with statistically significant (P < 0.05) odds ratios greater than 1.00, being 1.88 (1.13–3.17) and 2.93 (1.23–6.95), respectively. Odds ratios adjusted for all other variables showed similar associations, but only faecal haemoglobin and family history of polyps had significant associations.

Conclusions: Faecal haemoglobin is the most important factor to be considered when deciding which patients presenting in primary care with lower bowel symptoms would benefit most from referral for colonoscopy.

Original languageEnglish
Pages (from-to)472-479
Number of pages8
JournalAnnals of Clinical Biochemistry
Volume56
Issue number4
Early online date30 Apr 2019
DOIs
Publication statusPublished - 1 Jul 2019

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Hemoglobins
Odds Ratio
Colonoscopy
Polyps
Inflammatory Bowel Diseases
Adenoma
Colorectal Neoplasms
Primary Health Care
Dietary supplements
Meats
Dietary Fiber
Medical problems
Dietary Supplements
Feces
Referral and Consultation
Smoking
Alcohols
Demography
Exercise
Hemorrhage

Keywords

  • Bowel disease
  • colorectal disease
  • faecal biomarkers
  • faecal haemoglobin
  • faecal immunochemical test
  • primary care

Cite this

@article{2272abb8381d442f93fd3a0bf06d1ddc,
title = "Do other variables add value to assessment of the risk of colorectal disease using faecal immunochemical tests for haemoglobin?",
abstract = "Background: Faecal immunochemical tests for haemoglobin have been recommended to assist in assessment of patients presenting in primary care with lower bowel symptoms. The aim was to assess if, and which, additional variables might enhance this use of faecal immunochemical tests.Methods: Faecal immunochemical test analysis has been a NHS Tayside investigation since December 2015. During the first year, 993 patients attending colonoscopy were invited to complete a detailed questionnaire on demographic background, symptoms, smoking status, alcohol use, dietary fibre, red and processed meat intake, physical activity, sitting time, dietary supplement use, family history of colorectal cancer, adenoma, inflammatory bowel disease and diabetes. Significant bowel disease was classified as colorectal cancer, advanced adenoma or inflammatory bowel disease.Results: A total of 470 (47.3{\%}) invitees agreed to complete the questionnaire and 408 (41.1{\%}) did. Unadjusted odds ratios for the presence of significant bowel disease compared with undetectable faecal haemoglobin increased with increasing faecal haemoglobin and for faecal haemoglobin 10–49, 50–199, 200–399 and ⩾400 μg Hb/g faeces were 0.95 (95{\%} CI: 0.16–5.63), 2.47 (0.55–1.03), 6.30 (1.08–36.65) and 18.90 (4.22–84.62), respectively. Rectal bleeding and family history of polyps were the only other variables with statistically significant (P < 0.05) odds ratios greater than 1.00, being 1.88 (1.13–3.17) and 2.93 (1.23–6.95), respectively. Odds ratios adjusted for all other variables showed similar associations, but only faecal haemoglobin and family history of polyps had significant associations.Conclusions: Faecal haemoglobin is the most important factor to be considered when deciding which patients presenting in primary care with lower bowel symptoms would benefit most from referral for colonoscopy.",
keywords = "Bowel disease, colorectal disease, faecal biomarkers, faecal haemoglobin, faecal immunochemical test, primary care",
author = "Jayne Digby and Bob Steele and Strachan, {Judith A.} and Craig Mowat and Annie Anderson and Rebecca McCann and Louise Law and Callum Fraser",
note = "This study was funded by a grant from the Chief Scientist Office (grant number ASM/14/4).",
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Do other variables add value to assessment of the risk of colorectal disease using faecal immunochemical tests for haemoglobin? / Digby, Jayne (Lead / Corresponding author); Steele, Bob; Strachan, Judith A.; Mowat, Craig; Anderson, Annie; McCann, Rebecca; Law, Louise ; Fraser, Callum.

In: Annals of Clinical Biochemistry, Vol. 56, No. 4, 01.07.2019, p. 472-479.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Do other variables add value to assessment of the risk of colorectal disease using faecal immunochemical tests for haemoglobin?

AU - Digby, Jayne

AU - Steele, Bob

AU - Strachan, Judith A.

AU - Mowat, Craig

AU - Anderson, Annie

AU - McCann, Rebecca

AU - Law, Louise

AU - Fraser, Callum

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N2 - Background: Faecal immunochemical tests for haemoglobin have been recommended to assist in assessment of patients presenting in primary care with lower bowel symptoms. The aim was to assess if, and which, additional variables might enhance this use of faecal immunochemical tests.Methods: Faecal immunochemical test analysis has been a NHS Tayside investigation since December 2015. During the first year, 993 patients attending colonoscopy were invited to complete a detailed questionnaire on demographic background, symptoms, smoking status, alcohol use, dietary fibre, red and processed meat intake, physical activity, sitting time, dietary supplement use, family history of colorectal cancer, adenoma, inflammatory bowel disease and diabetes. Significant bowel disease was classified as colorectal cancer, advanced adenoma or inflammatory bowel disease.Results: A total of 470 (47.3%) invitees agreed to complete the questionnaire and 408 (41.1%) did. Unadjusted odds ratios for the presence of significant bowel disease compared with undetectable faecal haemoglobin increased with increasing faecal haemoglobin and for faecal haemoglobin 10–49, 50–199, 200–399 and ⩾400 μg Hb/g faeces were 0.95 (95% CI: 0.16–5.63), 2.47 (0.55–1.03), 6.30 (1.08–36.65) and 18.90 (4.22–84.62), respectively. Rectal bleeding and family history of polyps were the only other variables with statistically significant (P < 0.05) odds ratios greater than 1.00, being 1.88 (1.13–3.17) and 2.93 (1.23–6.95), respectively. Odds ratios adjusted for all other variables showed similar associations, but only faecal haemoglobin and family history of polyps had significant associations.Conclusions: Faecal haemoglobin is the most important factor to be considered when deciding which patients presenting in primary care with lower bowel symptoms would benefit most from referral for colonoscopy.

AB - Background: Faecal immunochemical tests for haemoglobin have been recommended to assist in assessment of patients presenting in primary care with lower bowel symptoms. The aim was to assess if, and which, additional variables might enhance this use of faecal immunochemical tests.Methods: Faecal immunochemical test analysis has been a NHS Tayside investigation since December 2015. During the first year, 993 patients attending colonoscopy were invited to complete a detailed questionnaire on demographic background, symptoms, smoking status, alcohol use, dietary fibre, red and processed meat intake, physical activity, sitting time, dietary supplement use, family history of colorectal cancer, adenoma, inflammatory bowel disease and diabetes. Significant bowel disease was classified as colorectal cancer, advanced adenoma or inflammatory bowel disease.Results: A total of 470 (47.3%) invitees agreed to complete the questionnaire and 408 (41.1%) did. Unadjusted odds ratios for the presence of significant bowel disease compared with undetectable faecal haemoglobin increased with increasing faecal haemoglobin and for faecal haemoglobin 10–49, 50–199, 200–399 and ⩾400 μg Hb/g faeces were 0.95 (95% CI: 0.16–5.63), 2.47 (0.55–1.03), 6.30 (1.08–36.65) and 18.90 (4.22–84.62), respectively. Rectal bleeding and family history of polyps were the only other variables with statistically significant (P < 0.05) odds ratios greater than 1.00, being 1.88 (1.13–3.17) and 2.93 (1.23–6.95), respectively. Odds ratios adjusted for all other variables showed similar associations, but only faecal haemoglobin and family history of polyps had significant associations.Conclusions: Faecal haemoglobin is the most important factor to be considered when deciding which patients presenting in primary care with lower bowel symptoms would benefit most from referral for colonoscopy.

KW - Bowel disease

KW - colorectal disease

KW - faecal biomarkers

KW - faecal haemoglobin

KW - faecal immunochemical test

KW - primary care

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JO - Annals of Clinical Biochemistry

JF - Annals of Clinical Biochemistry

SN - 0004-5632

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