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Diagnosis of occult gastrointestinal lesions by stool guaiac testing in a geriatric hospital
Insights
Routine fecal occult blood testing using the guaiac method in long-term care facilities can effectively screen for gastrointestinal bleeding lesions. This screening identified lesions in 20 of 21 patients, highlighting its diagnostic value.
Area of Science:
- Gastroenterology
- Internal Medicine
- Geriatric Medicine
Background:
- Gastrointestinal (GI) bleeding lesions are a concern in chronically ill hospitalized patients.
- Fecal occult blood testing is a common screening method for GI bleeding.
Purpose of the Study:
- To evaluate the effectiveness of the fecal guaiac test for screening GI bleeding lesions in a long-term care facility.
- To determine the diagnostic yield of positive fecal guaiac tests in this population.
Main Methods:
- 450 chronically ill patients (average age 70) underwent 6 fecal guaiac tests over three days on a standardized diet.
- Patients with positive fecal hemoccult tests (21 individuals) were further investigated using GI series, barium enema, and fiberoptic examinations.
- Diagnostic accuracy and lesion detection rates were analyzed.
Main Results:
- The fecal guaiac test yielded positive results in 4.7% of the population.
- Further investigations confirmed GI lesions in 20 out of 21 patients with positive tests, including large-bowel tumors, duodenal ulcers, gastric cancer, and diverticulosis.
- A high incidence of duodenal ulcers was noted in the positive cases.
Conclusions:
- Routine fecal hemoccult testing is valuable for screening institutionalized populations for GI tract lesions.
- The test demonstrated a high diagnostic yield, identifying significant pathologies.
- Regular screening, once or twice annually, is recommended for whole institutional populations.
Abstract:
In a long-term care facility, the fecal guaiac test for occult blood was used as a screening method to detect gastrointestinal (GI) bleeding lesions. The study involved 450 chronically ill hospitalized patients whose average age was 70 years. Each underwent 6 fecal guaiac tests for three consecutive days while receiving a standardized meat-free, high-fiber diet. The 21 patients in whom the fecal hemoccult test yielded positive findings were further studied with x-ray upper GI series, barium enema, and fiberoptic examination of the upper and lower GI tract when necessary. In 4.7 percent of this population, the guaiac test gave positive results, which usually involved only 1 or 2 of the 6 guaiac slides. On further study it was found that 2 patients had large-bowel tumors, 5 had duodenal ulcers, 1 had gastric cancer, and 7 had diverticulosis. The incidence of colon cancer in this population was the same as that reported in other studies, but the incidence of duodenal ulcers was high. In 20 of the 21 patients with positive test findings, a lesion of the GI tract was found. The therapeutic implications of such screening are important. This study emphasizes the value of routine fecal hemoccult testing of whole institutional populations once or twice a year.