Don't Fall for the FOBT Fib-An Observational Study

Fecal occult blood testing (FOBT) is often ordered in emergency settings for patients presenting with hematemesis or hematochezia. However, FOBT is FDA-approved solely for colorectal cancer screening in the outpatient setting. Its use in evaluating suspected acute gastrointestinal (GI) bleeding may misguide clinical decision-making and contribute to unnecessary healthcare utilization.

This retrospective observational study assessed the diagnostic utility of FOBT in patients admitted to Sierra View Medical Center between 2022 and 2024 with suspected GI bleeding. Electronic medical records were reviewed to identify patients with positive FOBT results and an admitting diagnosis related to GI bleeding. Data collected included physical examination findings, hemoglobin trends, transfusion requirements, and endoscopic outcomes.

Seventy-five patients were identified, of whom 70 met inclusion criteria. Among these, only 11 patients (15.7%) underwent endoscopic intervention for an acute bleeding source. Patients requiring endoscopic intervention were approximately 10% more likely to have positive physical exam findings compared to those who did not.

The findings support existing evidence that FOBT has limited diagnostic value in the setting of suspected acute GI bleeding. Current gastroenterology guidelines do not recommend the use of single-card FOBT for this indication. This study reinforces that positive FOBT results should not guide admission or diagnostic decision-making in the inpatient evaluation of suspected GI bleeding.