FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 339:153-159 July 16, 1998 Number 3 Next

	Full Text PDF Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Although bleeding lesions anywhere in the gastrointestinal tract can cause a positive reaction on guaiac-based fecal occult-blood tests, the relative frequency of upper gastrointestinal and colonic lesions is unknown.

Methods During a period of 30 months, we prospectively studied all patients with at least one stool specimen containing fecal occult blood who were referred for further evaluation. Fecal occult blood was detected by standard guaiac-based tests of stool specimens obtained as part of routine screening or of stool obtained by digital rectal examination. Patients with documented iron-deficiency anemia or active gastrointestinal bleeding were excluded from the study. All participants had a detailed history taken and underwent colonoscopy, followed by esophagogastroduodenoscopy.

Results Of the 409 patients with fecal occult blood who were referred, 310 were potentially eligible to participate, and 248 (mean age, 61 years; range, 40 to 89) were studied; 40 percent were women. We identified lesions consistent with occult bleeding in 119 patients (48 percent); in 71 bleeding lesions were found in the upper gastrointestinal tract, and in 54 they were identified in the colon. Six patients had abnormalities in both areas. The most common upper gastrointestinal lesions were esophagitis (23 patients), gastric ulcer (14), gastritis (12), and duodenal ulcer (10). Thirty patients with lesions in the upper gastrointestinal tract were long-term users of aspirin, ethanol, nonsteroidal antiinflammatory drugs, or a combination of these substances. The most common colonic lesions were adenomas more than 1.0 cm in diameter (29 patients), carcinoma (13), colitis (5), and vascular ectasia (5). Although the overall sensitivity of symptoms for the detection of gastrointestinal lesions was low, logistic-regression analysis demonstrated that the presence of symptoms in the upper gastrointestinal tract was associated with the detection of lesions in the upper gastrointestinal tract (odds ratio, 2.6; 95 percent confidence interval, 1.4 to 4.7). In both patients with symptoms and those without symptoms, the prevalence of lesions in the upper gastrointestinal tract was greater than or equal to that of colonic lesions.

Conclusions In a group of patients with positive fecal occult-blood tests who were referred for further evaluation, from which those with iron-deficiency anemia and active bleeding had been excluded, upper gastrointestinal lesions were identified more frequently than colonic lesions.

Source Information

From the Division of Gastroenterology and the Department of Medicine, Duke University Medical Center, Durham, N.C. (D.C.R., L.L.S.); and the Division of Gastroenterology and the Department of Medicine, University of California, San Francisco (J.K., J.P.C., K.M.).

Address reprint requests to Dr. Rockey at the Liver Research Laboratory, Duke University Medical Center, Sands Bldg., Rm. 334, Research Dr., Box 3083, Durham, NC 27710.

Full Text of this Article

This article has been cited by other articles:

• Everson, G. T. (2009). Upper and Lower GI Bleeding in the ICU. ACCP Crit Care Med Brd Rev 20: 85-92 [Full Text]  
• Thalmann, M, Sodeck, G H, Kavouras, S, Matalas, A, Skenderi, K, Yannikouris, N, Domanovits, H, Rao, A, Simons, S, Yazaki, E (2006). Proton pump inhibition prevents gastrointestinal bleeding in ultramarathon runners: a randomised, double blinded, placebo controlled study * Commentary * Commentary * Commentary.. Br. J. Sports. Med. 40: 359-362 [Abstract] [Full Text]  
• Macari, M., Bini, E. J. (2005). CT Colonography: Where Have We Been and Where Are We Going?. Radiology 237: 819-833 [Abstract] [Full Text]  
• Niv, E., Elis, A., Zissin, R., Naftali, T., Novis, B., Lishner, M. (2005). Iron deficiency anemia in patients without gastrointestinal symptoms--a prospective study. Fam Pract 22: 58-61 [Abstract] [Full Text]  
• Macari, M., Bini, E. J., Jacobs, S. L., Naik, S., Lui, Y. W., Milano, A., Rajapaksa, R., Megibow, A. J., Babb, J. (2004). Colorectal Polyps and Cancers in Asymptomatic Average-Risk Patients: Evaluation with CT Colonography. Radiology 230: 629-636 [Abstract] [Full Text]  
• Strul, H., Arber, N. (2002). Fecal occult blood test for colorectal cancer screening. Ann Oncol 13: 51-56 [Full Text]  
• Harewood, G. C., McConnell, J. P., Harrington, J. J., Mahoney, D. W., Ahlquist, D. A. (2002). Detection of Occult Upper Gastrointestinal Tract Bleeding: Performance Differences in Fecal Occult Blood Tests. Mayo Clin Proc. 77: 23-28 [Abstract]  
• Macari, M., Milano, A., Lavelle, M., Berman, P., Megibow, A. J. (2000). Comparison of Time-Efficient CT Colonography with Two-and Three-Dimensional Colonic Evaluation for Detecting Colorectal Polyps. Am. J. Roentgenol. 174: 1543-1549 [Abstract] [Full Text]  
• Jolobe, O M P (2000). Medicine in the elderly: Does this elderly patient have iron deficiency anaemia, and what is the underlying cause?. Postgrad. Med. J. 76: 195-198 [Abstract] [Full Text]  
• Bini, E. J., Rajapaksa, R. C., Weinshel, E. H. (1999). The Findings and Impact of Nonrehydrated Guaiac Examination of the Rectum (FINGER) Study: A Comparison of 2 Methods of Screening for Colorectal Cancer in Asymptomatic Average-Risk Patients. Arch Intern Med 159: 2022-2026 [Abstract] [Full Text]  
• Greenberger, N. J. (1999). Update in Gastroenterology. ANN INTERN MED 131: 445-452 [Full Text]  
• Rockey, D. C. (1999). Occult Gastrointestinal Bleeding. NEJM 341: 38-46 [Full Text]  
• Rosenthal, D. S., Feldman, G., Levinson, W. (1999). Talking With Patients About Screening for Prostate Cancer. JAMA 281: 133-133 [Full Text]  
• (1998). FOBT Detects More Upper than Lower GI Lesions.. JWatch General 1998: 2-2 [Full Text]