Understanding the Utility of Fecal Occult Blood Testing in Hospitalized Patients With Suspected GI Bleeding

Colorectal cancer (CRC) is one of the leading causes of cancer-related mortality worldwide. There have been increasing efforts to reduce its incidence and mortality. Screening plays a crucial role, with various tests such as the fecal occult blood test (FOBT), colonoscopy, and flexible sigmoidoscopy commonly used for investigation. FOBT is a Food and Drug Administration (FDA) approved screening tool commonly used in acute healthcare settings for early detection of CRC. We report a 50-year-old man presenting with shortness of breath, chills, and malaise with findings positive for pneumonia. Laboratory tests revealed anemia as an incidental finding. A subsequent FOBT came back positive, and the patient was admitted for further gastrointestinal testing. Esophagogastroduodenoscopy (EGD) and colonoscopy were performed, but no significant findings were observed. This case report focuses on the overuse of FOBT testing during hospital admission, despite its limited impact on patient care in acute settings. Key takeaways include being aware of the potential for false positive and false negative results from a FOBT. Using the test carefully can help reduce both direct and indirect healthcare costs for hospitalized patients, as well as minimize the use of hospital resources. The test should primarily be used for CRC screening in the outpatient setting.