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Fecal occult blood testing (FOBT), as its name implies, aims to detect subtle blood loss in the gastrointestinal tract, anywhere from the mouth to the colon.Positive tests ("positive stool") may result from either upper gastrointestinal bleeding or lower gastrointestinal bleeding and warrant further investigation for peptic ulcers or a malignancy (such as colorectal cancer or gastric cancer).
The stool guaiac test involves fasting from iron supplements, red meat (the blood it contains can turn the test positive), certain vegetables (which contain a chemical with peroxidase properties that can turn the test positive), and vitamin C and citrus fruits (which can turn the test falsely negative) for a period of time before the test.
Occult blood may refer to: Fecal occult blood, blood present in the feces that is not visibly apparent; Hematuria, the presence of red blood cells in the urine
Hematochezia is defined as bright red blood seen in the toilet either inside of, or surrounding the stool. [6] Hematochezia is typically presumed to come from the lower portion of the GI tract, and the initial steps of diagnosis include a digital rectal exam with fecal occult blood test, which if positive, will lead to a colonoscopy.
A multi-target stool DNA test was approved in August 2014 by the FDA as a screening test for non-symptomatic, average-risk adults 50 years or older. [8] A 2017 study found this testing to be less cost effective compared to colonoscopy or fecal occult blood testing. [9]
Diagnosis is often based on direct observation of blood in the stool or vomit. Although fecal occult blood testing has been used in an emergency setting, this use is not recommended as the test has only been validated for colon cancer screening. [19] Differentiating between upper and lower bleeding in some cases can be difficult.
The fecal immunochemical test (FIT) is a diagnostic technique that examines stool samples for traces of non-visible blood, which could potentially indicate conditions including bowel cancer. [1] Symptoms which could be caused by bowel cancer and suggest a FIT include a change in bowel habit, anaemia , unexplained weight loss, and abdominal pain .
Although the digital rectal exam (DRE) is commonly used as a way to obtain a stool sample for a FOBT (fecal occult blood test) in an office based setting, this is an insufficient way of screening for colorectal cancer and is not recommended.