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5.
Med Clin North Am ; 104(5): 827-842, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32773048

RESUMO

The prevalence of urinary incontinence and other lower urinary tract symptoms increases with older age. These symptoms are more noticeable in men after the seventh decade of life and in women after menopause. Constipation and fecal incontinence are major causes of symptoms in elderly patients and can significantly impair quality of life. This article summarizes the current literature regarding the occurrence and implications of lower urinary tract and bowel symptoms in the geriatric population.


Assuntos
Enteropatias , Qualidade de Vida , Doenças Urológicas , Idoso , Constipação Intestinal/epidemiologia , Incontinência Fecal/epidemiologia , Avaliação Geriátrica , Humanos , Enteropatias/diagnóstico , Enteropatias/fisiopatologia , Enteropatias/psicologia , Prevalência , Incontinência Urinária/epidemiologia , Doenças Urológicas/diagnóstico , Doenças Urológicas/fisiopatologia , Doenças Urológicas/psicologia
6.
PLoS One ; 15(8): e0238079, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32845916

RESUMO

BACKGROUND: Sitosterolemia is an inherited lipid disorder which presents with elevated serum sitosterol and can result in an increased risk of premature cardiovascular disease. However, sitosterol cannot be accurately measured by routine diagnostic assays, meaning that sitosterolemia diagnosis can often be difficult, especially with many clinical features overlapping with familial hypercholesterolemia. With such complications resulting in increasing reports of misdiagnosis, the prevalence of sitosterolemia is predicted to be much higher than previously reported. METHODS: Gas chromatography-mass spectrometry was utilized to measure sitosterol levels of normocholesterolemic and hypercholesterolemic children. Subsequently, an epidemiologically determined cutoff level of sitosterol was calculated and applied to estimate the prevalence of children with increased sitosterol and identify potential sitosterolemia patients. Massively parallel sequencing was used to confirm the diagnosis in suspected patients. RESULTS: Samples from 109 normocholesterolemic and 220 hypercholesterolemic were tested for phytosterols. Sitosterol and campesterol levels were significantly increased in hypercholesterolemic children (mean 22.0±45.9 µmol/L for sitosterol and 26.0±32.8 µmol/L for campesterol) compared to normocholesterolemic children (mean 12.1±4.9 µmol/L for sistosterol and 14.8±6.7 µmol/L for campesterol). Via application of a cutoff of 35.9 µmol/L, the prevalence rates for increased and overtly increased sitosterol in hypercholesterolemic children were 6.4% and 1.4% respectively. Furthermore, 3 suspected sitosterolemia patients were identified, with 2 patients receiving molecular confirmation for sitosterolemia diagnosis. CONCLUSIONS: Our findings reaffirm that the prevalence of sitosterolemia is probably much higher than previously reported, which also indicates the significant risk of misdiagnosis of sitosterolemia with familial hypercholesterolemia. Special lipid testing including sitosterol, especially in children with uncontrolled hypercholesterolemia, is recommended in children in order to identify potential sitosterolemia patients that would otherwise be neglected.


Assuntos
Hipercolesterolemia/diagnóstico , Sitosteroides/análise , Membro 5 da Subfamília G de Transportadores de Cassetes de Ligação de ATP/genética , Membro 8 da Subfamília G de Transportadores de Cassetes de Ligação de ATP/genética , Adolescente , Criança , Pré-Escolar , Colesterol/análogos & derivados , Colesterol/análise , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Hipercolesterolemia/epidemiologia , Hipercolesterolemia/genética , Lactente , Enteropatias/diagnóstico , Enteropatias/epidemiologia , Enteropatias/genética , Erros Inatos do Metabolismo Lipídico/diagnóstico , Erros Inatos do Metabolismo Lipídico/epidemiologia , Erros Inatos do Metabolismo Lipídico/genética , Lipoproteínas/genética , Masculino , Linhagem , Fitosteróis/efeitos adversos , Fitosteróis/análise , Fitosteróis/genética , Prevalência
9.
Rev. argent. coloproctología ; 31(2): 54-63, jun. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1117010

RESUMO

La endometriosis es una de las patologías ginecológicas benignas más frecuente, ocurre en un 7-10% de las mujeres en edad reproductiva y es causal de dolores crónicos e infertilidad. Se trata de una población joven y sana por lo demás. La sospecha diagnóstica de esta entidad debe ser alta y su manejo multidisciplinario.La endometriosis colorrectal representa una variable altamente incapacitante y es aquí donde se plantea la necesidad de un tratamiento más agresivo para su resolución. Frente a esto nos preguntamos, ¿qué rol tiene la cirugía?, ¿cuáles serían sus ventajas y desventajas?, ¿por qué deberíamos elegirla como método terapéutico?.La presente monografía fue inspirada en todas las pacientes que nos plantearon esta controversia. Que motivaron interconsultas, ateneos, búsqueda de bibliografía. Que generaron discusiones, dudas e incertidumbres y nos hicieron salir del rol de cirujanos al que estamos habituados y nos enseñaron a acompañar, cuando no pudimos curar


Assuntos
Humanos , Feminino , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Endometriose/cirurgia , Enteropatias/cirurgia , Equipe de Assistência ao Paciente , Diagnóstico por Imagem , Resultado do Tratamento , Laparoscopia/métodos , Dietoterapia , Endometriose/diagnóstico , Endometriose/tratamento farmacológico , Antagonistas de Hormônios/uso terapêutico , Enteropatias/diagnóstico , Enteropatias/tratamento farmacológico
10.
J Urol ; 204(6): 1333-1340, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32469626

RESUMO

PURPOSE: Bladder-bowel questionnaires are an important tool in diagnosing nonneurogenic bladder-bowel dysfunction in children. We report the validity and reliability of a bladder-bowel questionnaire that has been in clinical use at our institution for decades. MATERIALS AND METHODS: The bladder-bowel questionnaire contains 13 questions, with answers ranging from never (score of 0) to daily (3). The questionnaire was answered by 139 healthy controls and 134 children 3 to 16 years old diagnosed with bladder-bowel dysfunction by a pediatric urologist/urotherapist. A subdiagnosis of overactive bladder or dysfunctional voiding was made in each patient. Bladder-bowel questionnaire scales were developed and evaluated against hypotheses of validity (known groups/convergent/discriminating) and reliability (internal consistency/retest reliability), sensitivity and specificity. Responsiveness was tested in 80 patients who answered the bladder-bowel questionnaire after treatment. RESULTS: A total bladder-bowel dysfunction score scale demonstrated the ability to discriminate between patients with bladder-bowel dysfunction and healthy subjects. It resulted in a ROC curve with AUC of 0.96. The maximized sensitivity was 94% and specificity was 89% for a cutoff score of 7. Two subscales were identified referring to 6 filling phase items and 3 voiding phase items. When tested in patients with overactive bladder and dysfunctional voiding, respectively, multivariable scales performed sufficiently to discriminate between those with and without overactive bladder, and those with and without dysfunctional voiding. All of these scales fulfilled the evaluated requirements for validity and reliability. At 1 year after treatment all scale scores corresponded to patient improvement (p <0.0001), suggesting the bladder-bowel questionnaire can detect clinical change over time. CONCLUSIONS: The bladder-bowel questionnaire is valid and reliable for diagnosing bladder-bowel dysfunction in pediatric patients, and overactive bladder and dysfunctional voiding in those with bladder-bowel dysfunction.


Assuntos
Enteropatias/diagnóstico , Índice de Gravidade de Doença , Bexiga Urinária Hiperativa/diagnóstico , Micção/fisiologia , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Defecação/fisiologia , Feminino , Voluntários Saudáveis , Humanos , Enteropatias/fisiopatologia , Masculino , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Suécia , Bexiga Urinária Hiperativa/fisiopatologia
11.
Am J Cardiol ; 125(9): 1312-1316, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32143815

RESUMO

Sitosterolemia is a rare lipid metabolism disease with heterogeneous manifestations. Atherosclerosis can occur in children, and therefore, early detection, diagnosis, and treatment of this disease are important. We studied 18 pediatric patients with sitosterolemia who showed a significant increase in plasma lipid levels and analyzed their clinical, biochemical, and genetic characteristics. We recorded the initial serum lipid results and clinical manifestations of the patients. Lipid and plant sterol levels were measured after homozygous or compound heterozygous mutations of ABCG5 or ABCG8 were identified by genetic testing. Plasma plant sterol levels were analyzed by gas chromatography. Fourteen cases of sitosterolemia were examined by ultrasound and echocardiography. The initial total cholesterol and low-density lipoprotein levels of the children were significantly increased, but then markedly decreased after diet control or drug treatment, and even reached normal levels. Carotid atherosclerosis and aortic valve regurgitation were present in three of 14 patients. Serum lipid levels of children with sitosterolemia and xanthomas were notably higher than those without xanthomas. There were no significant differences in clinical manifestations between patients with different genotypes. In conclusion, sitosterolemia should be considered in children with hyperlipidemia who do not present with xanthomas, especially with a significant increase in total cholesterol and low-density lipoprotein levels. There does not appear to be a correlation between clinical phenotype and genotype.


Assuntos
Hipercolesterolemia/diagnóstico , Enteropatias/diagnóstico , Erros Inatos do Metabolismo Lipídico/diagnóstico , Fitosteróis/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Hipercolesterolemia/sangue , Lactente , Enteropatias/sangue , Erros Inatos do Metabolismo Lipídico/sangue , Masculino , Fitosteróis/sangue
12.
Dig Dis Sci ; 65(5): 1307-1314, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32162121

RESUMO

Bleeding from the small intestine remains a clinically challenging diagnostic and therapeutic problem. It may be minor, requiring only supplemental iron treatment, to patients who have severe overt bleeding that requires multimodal intervention. This article provides an up-to-date review of the state-of-the-art of diagnosis and treatment of small intestinal bleeding.


Assuntos
Endoscopia por Cápsula/métodos , Hemorragia Gastrointestinal/diagnóstico , Enteropatias/diagnóstico , Melena/diagnóstico , Adulto , Idoso , Diagnóstico Diferencial , Feminino , Hemorragia Gastrointestinal/complicações , Humanos , Enteropatias/complicações , Intestino Delgado/diagnóstico por imagem , Masculino , Melena/etiologia , Pessoa de Meia-Idade
13.
Zhonghua Nei Ke Za Zhi ; 59(2): 124-128, 2020 Feb 01.
Artigo em Chinês | MEDLINE | ID: mdl-32074685

RESUMO

Objective: To analyze the clinical value of capsule endoscopy (CE) in small intestinal diseases and to explore the correlation between the diagnosis and clinical characteristics. Methods: From June 2016 to April 2019, a total of 194 patients receiving CE were enrolled in the Department of Gastroenterology, Shanxi People's Hospital, including 68 patients with obscure gastrointestinal bleeding, 104 with chronic abdominal pain and 22 with diarrhea. Results: The detection rate of small intestinal lesions by CE was 53.6%(104/194), of which gastrointestinal bleeding was 66.2% (45/68), chronic abdominal pain was 53.8%(56/104), and diarrhea was 13.6%(3/22). The first three positive diagnostic criteria of CE for gastrointestinal bleeding were non-specific inflammation, small intestinal ulcer and vascular malformation. CE findings in patients with abdominal pain were non-specific inflammation, small intestinal ulcer and Crohn's disease; while the major endoscopic presentations in patients with diarrhea were small intestinal ulcer and non-specific inflammation. Logistic regression analysis suggested that the clinical manifestations and gender were correlated with positive diagnosis by CE (P<0.05), and the positive diagnostic rate of CE in female patients was significantly lower than that in male patients [31.6%(25/79) vs. 51.3%(59/115), P<0.05]. The diagnostic rates of CE in patients with gastrointestinal bleeding and chronic abdominal pain were similar [55.9%(38/68) vs. 41.4%(43/104)], which was significantly higher than those with diarrhea [9.1%(2/22), P<0.05]. Conclusions: Capsule endoscopy has a high detection rate for small intestinal diseases, which could be the first choice in patients with unexplained gastrointestinal bleeding. Male patients and gastrointestinal bleeding are predictors of positive findings by CE.


Assuntos
Endoscopia por Cápsula , Doença de Crohn/diagnóstico , Endoscopia Gastrointestinal/métodos , Hemorragia Gastrointestinal/diagnóstico , Enteropatias/diagnóstico , Intestino Delgado/patologia , Doença de Crohn/epidemiologia , Feminino , Hemorragia Gastrointestinal/epidemiologia , Humanos , Enteropatias/epidemiologia , Masculino
14.
PLoS Negl Trop Dis ; 14(1): e0007975, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31929525

RESUMO

BACKGROUND: A major limitation to understanding the etiopathogenesis of environmental enteric dysfunction (EED) is the lack of a comprehensive, reproducible histologic framework for characterizing the small bowel lesions. We hypothesized that the development of such a system will identify unique histology features for EED, and that some features might correlate with clinical severity. METHODS: Duodenal endoscopic biopsies from two cohorts where EED is prevalent (Pakistan, Zambia) and North American children with and without gluten sensitive enteropathy (GSE) were processed for routine hematoxylin & eosin (H&E) staining, and scanned to produce whole slide images (WSIs) which we shared among study pathologists via a secure web browser-based platform. A semi-quantitative scoring index composed of 11 parameters encompassing tissue injury and response patterns commonly observed in routine clinical practice was constructed by three gastrointestinal pathologists, with input from EED experts. The pathologists then read the WSIs using the EED histology index, and inter-observer reliability was assessed. The histology index was further used to identify within- and between-child variations as well as features common across and unique to each cohort, and those that correlated with host phenotype. RESULTS: Eight of the 11 histologic scoring parameters showed useful degrees of variation. The overall concordance across all parameters was 96% weighted agreement, kappa 0.70, and Gwet's AC 0.93. Zambian and Pakistani tissues shared some histologic features with GSE, but most features were distinct, particularly abundance of intraepithelial lymphocytes in the Pakistani cohort, and marked villous destruction and loss of secretory cell lineages in the Zambian cohort. CONCLUSIONS: We propose the first EED histology index for interpreting duodenal biopsies. This index should be useful in future clinical and translational studies of this widespread, poorly understood, and highly consequential disorder, which might be caused by multiple contributing processes, in different regions of the world.


Assuntos
Desenvolvimento Infantil , Meio Ambiente , Transtornos do Crescimento/etiologia , Enteropatias/diagnóstico , Enteropatias/epidemiologia , Biópsia , Criança , Pré-Escolar , Duodeno/patologia , Feminino , Transtornos do Crescimento/epidemiologia , Humanos , Lactente , Enteropatias/complicações , Masculino , América do Norte/epidemiologia , Paquistão/epidemiologia , Zâmbia/epidemiologia
15.
Curr Gastroenterol Rep ; 22(1): 4, 2020 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-31940112

RESUMO

PURPOSE OF REVIEW: Small bowel diverticulosis is a well-known clinical entity whose diagnosis and management has evolved in recent years. This review covers pathophysiology, incidence, and prevalence, and it also provides an update on modern diagnosis and management. Meckel's diverticula are covered elsewhere in this volume. RECENT FINDINGS: CT scan and MRI have largely supplanted barium follow-through for diagnosis. No intervention is needed in asymptomatic individuals. Endoscopic management is playing an increasing role for both bleeding and resection of intraduodenal diverticula, but surgical intervention remains the only definitive intervention for other complications like diverticulitis and small bowel obstruction. Small bowel diverticulosis is an uncommon condition which is associated with numerous possible complications. While endoscopy is playing an increasingly large role in management, surgical resection remains the treatment of choice for most complications. A high index of suspicion is needed in order to diagnose this entity.


Assuntos
Divertículo/diagnóstico , Enteropatias/diagnóstico , Divertículo/epidemiologia , Divertículo/etiologia , Divertículo/terapia , Humanos , Enteropatias/epidemiologia , Enteropatias/etiologia , Enteropatias/terapia , Intestino Delgado/fisiopatologia
16.
Vet Clin North Am Equine Pract ; 36(1): 105-120, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31982231

RESUMO

The gastrointestinal tract and liver comprise key components of the equine digestive system and together have important functions in metabolism, digestion, absorption, detoxification, and synthesis. Disorders of the gastrointestinal tract and liver are common in clinical practice and can cause a variety of clinical signs. Hematologic and biochemical analysis can be helpful for identifying organ dysfunction, narrowing down the differential diagnostic list, and monitoring progress and response to treatment. This article details hematologic and biochemical tests that are important in the evaluation of intestinal and hepatic diseases and reviews bloodwork trends frequently observed in adult horses affected by enteropathy or hepatopathy.


Assuntos
Doenças dos Cavalos/patologia , Enteropatias/veterinária , Hepatopatias/veterinária , Animais , Doenças dos Cavalos/diagnóstico , Cavalos , Enteropatias/diagnóstico , Enteropatias/patologia , Hepatopatias/diagnóstico , Hepatopatias/patologia , Patologia Clínica
17.
J Gastroenterol Hepatol ; 35(8): 1340-1346, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31999379

RESUMO

BACKGROUND AND AIMS: Small intestinal lesions in patients with Behçet disease (BD) have a risk of perforation and hemorrhage requiring surgery. However, no screening strategy for such lesions has been established. We investigated small intestinal lesions in BD patients with video capsule endoscopy (VCE) and analyzed clinical characteristics to identify noninvasive biomarkers of such lesions. METHODS: This study included 33 BD patients who underwent VCE (PillCam® SB3) at our institution from June 2016 to January 2019. Clinical characteristics, including age, sex, disease duration, body mass index, gastrointestinal symptoms, eye involvement, and blood examinations, were obtained from the medical records of 27 of the 33 patients. Fecal immunochemical tests for hemoglobin, fecal calprotectin (FC), and fecal lactoferrin (FL) were measured. VCE findings of 145 healthy Japanese individuals from a previous report were used as controls. RESULTS: Two intestinal BD patients were included in the 27 patients. We observed that BD patients exhibit more small intestinal lesions compared with healthy individuals, including erosions, ulcers, and total lesions (erosions or ulcers). FC and FL levels were significantly higher in patients with versus without small intestinal lesions (P = 0.034 and P = 0.046, respectively). Receiver operating characteristic analyses demonstrated that FC (cutoff value = 119 µg/g) and FL (cutoff value = 17 µg/g) were biomarkers for small intestinal lesions in patients with BD. CONCLUSION: The present study using VCE showed that patients with BD had more small intestinal lesions than healthy individuals. FC and FL could be useful for screening BD patients who may have small intestinal lesions.


Assuntos
Síndrome de Behçet/complicações , Endoscopia por Cápsula , Fezes/química , Enteropatias/diagnóstico , Enteropatias/etiologia , Intestino Delgado , Lactoferrina/análise , Complexo Antígeno L1 Leucocitário/análise , Adolescente , Adulto , Biomarcadores/análise , Feminino , Humanos , Enteropatias/diagnóstico por imagem , Enteropatias/epidemiologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Fatores de Risco , Adulto Jovem
18.
Dig Endosc ; 32(2): 204-218, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31596970

RESUMO

Small-bowel bleeding accounts for the majority of obscure gastrointestinal bleeding, but it is caused by various types of small bowel disease, upper gastrointestinal disease, and colorectal disease. For the diagnosis, history taking and physical examination are required, leading to a determination of what diseases are involved. Next, cross-sectional imaging, such as computed tomography, should be carried out, followed by the latest enteroscopy such as small bowel capsule endoscopy and deep enteroscopy according to the severity of hemorrhage and patient condition. After a comprehensive diagnosis, medical, enteroscopic, or surgical treatment should be selected. This article reviews recent advances in the endoscopic diagnosis of obscure gastrointestinal bleeding and compares perspectives of the management of obscure gastrointestinal bleeding in Japan with that in other countries.


Assuntos
Endoscopia por Cápsula/métodos , Endoscopia Gastrointestinal/métodos , Hemorragia Gastrointestinal/diagnóstico , Avaliação de Resultados em Cuidados de Saúde , Guias de Prática Clínica como Assunto , Idoso , Meios de Contraste , Endoscopia Gastrointestinal/normas , Europa (Continente) , Feminino , Hemorragia Gastrointestinal/cirurgia , Humanos , Enteropatias/diagnóstico , Enteropatias/patologia , Intestino Delgado/patologia , Japão , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Tomografia Computadorizada por Raios X/métodos , Estados Unidos
19.
Clin Transl Gastroenterol ; 10(12): e00093, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31789936

RESUMO

OBJECTIVES: Intestinal neuronal dysplasia (IND) is a common malformation of the enteric nervous system. Diagnosis requires a full-thickness colonic specimen and an experienced pathologist, emphasizing the need for noninvasive analytical methods. Recently, the methylation level of the Sox10 promoter has been found to be critical for enteric nervous system development. However, whether it can be used for diagnostic purposes in IND is unclear. METHODS: Blood and colon specimens were collected from 32 patients with IND, 60 patients with Hirschsprung disease (HD), and 60 controls. Sox10 promoter methylation in the blood and the Sox10 expression level in the colon were determined, and their correlation was analyzed. The diagnostic efficacy of blood Sox10 promoter methylation was analyzed by receiver operating characteristic curve. RESULTS: The blood level of Sox10 promoter methylation at the 32nd locus was 100% (90%-100%; 95% confidence interval [CI], 92.29%-96.37%) in control, 90% (80%-90%; 95% CI, 82.84%-87.83%) in HD, and 60% (50%-80%; 95% CI, 57.12%-69.76%) in IND specimens. Sox10 promoter methylation in the peripheral blood was negatively correlated with Sox10 expression in the colon, which was low in control, moderate in HD, and high in IND specimens (r = -0.89). The area under the curve of Sox10 promoter methylation in the diagnosis of IND was 0.94 (95% CI, 0.874-1.000, P = 0.000), with a cutoff value of 85% (sensitivity, 90.6%; specificity, 95.0%). By applying a cutoff value of 65%, promoter methylation was more indicative of IND than HD. DISCUSSION: The analysis of Sox10 promoter methylation in the peripheral blood can be used as a noninvasive method for IND diagnosis.


Assuntos
Metilação de DNA , Sistema Nervoso Entérico/anormalidades , Enteropatias/diagnóstico , Doenças do Sistema Nervoso/diagnóstico , Fatores de Transcrição SOXE/genética , Biomarcadores/sangue , Criança , Colo/patologia , Colo/cirurgia , Ilhas de CpG/genética , Diagnóstico Diferencial , Estudos de Viabilidade , Feminino , Doença de Hirschsprung/sangue , Doença de Hirschsprung/diagnóstico , Doença de Hirschsprung/genética , Doença de Hirschsprung/patologia , Humanos , Enteropatias/sangue , Enteropatias/genética , Enteropatias/patologia , Mucosa Intestinal/inervação , Masculino , Doenças do Sistema Nervoso/sangue , Doenças do Sistema Nervoso/genética , Doenças do Sistema Nervoso/patologia , Valor Preditivo dos Testes , Regiões Promotoras Genéticas/genética , Curva ROC , Fatores de Transcrição SOXE/metabolismo , Análise de Sequência de DNA
20.
BMC Gastroenterol ; 19(1): 213, 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31829141

RESUMO

BACKGROUND: Many patients present in primary care with lower bowel symptoms, but significant bowel disease (SBD), comprising colorectal cancer (CRC), advanced adenoma (AA), or inflammatory bowel disease (IBD), is uncommon. Quantitative faecal immunochemical tests for haemoglobin (FIT), which examine faecal haemoglobin concentrations (f-Hb), assist in deciding who would benefit from colonoscopy. Incorporation of additional variables in an individual risk-score might improve this approach. We investigated if the published f-Hb, age and sex test score (FAST score) added value. METHODS: Data from the first year of routine use of FIT in primary care in one NHS Board in Scotland were examined: f-Hb was estimated using one HM-JACKarc FIT system (Kyowa Medex Co., Ltd., Tokyo, Japan) with a cut-off for positivity ≥10 µg Hb/g faeces. 5660 specimens were received for analysis in the first year. 4072 patients were referred to secondary care: 2881 (70.6%) of these had returned a FIT specimen. Of those referred, 1447 had colonoscopy data as well as the f-Hb result (group A): 2521 patients, also with f-Hb, were not immediately referred (group B). The FAST score was assessed in both groups. RESULTS: 1196 (41.7%) of patients who returned a specimen for FIT analysis had f-Hb ≥10 µg Hb/g faeces. In group A, 252 of 296 (85.1%) with SBD had f-Hb > 10 µg Hb/g faeces, as did 528 of 1151 (45.8%) without SBD. Using a FAST score > 2.12, which gives high clinical sensitivity for CRC, only 1143 would have been referred for colonoscopy (21.0% reduction in demand): 286 of 296 (96.6%) with SBD had a positive FAST score, as did 857 of 1151 (74.5%) without SBD. However, one CRC, five AA and four IBD would have been missed. In group B, although 95.2% had f-Hb < 10 µg Hb/g faeces, 1371 (53.7%) had FAST score ≥ 2.12: clinical rationale led to only 122 of group B completing subsequent bowel investigations: a FAST score > 2.12 was found in 13 of 15 (86.7%) with SBD. CONCLUSIONS: The performance characteristics of the FAST score did not seem to enhance the utility of f-Hb alone. Locally-derived formulae might confer desired benefits.


Assuntos
Fatores Etários , Colonoscopia/estatística & dados numéricos , Hemoglobinas/análise , Enteropatias/diagnóstico , Sangue Oculto , Fatores Sexuais , Adenoma/diagnóstico , Biomarcadores/análise , Neoplasias do Colo/diagnóstico , Feminino , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Masculino , Valor Preditivo dos Testes , Neoplasias Retais/diagnóstico , Sensibilidade e Especificidade
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