Diagnostic work-up of patients presenting in primary care with lower abdominal symptoms: which faecal test and triage strategy should be used?

BMC Medicine

Commentary

Callum G. Fraser¹ 

[1] Centre for Research into Cancer Prevention and Screening, University of Dundee, Ninewells Hospital and Medical School, DD1 9SY, Dundee, Scotland, UK;

关键词: Colorectal cancer;    Faecal calprotectin;    Faecal haemoglobin;    Faecal immunochemical test;    Point-of-care;    Primary care;    Significant colorectal disease;   

DOI  :  10.1186/s12916-016-0694-3

 received in 2016-08-20, accepted in 2016-09-14,  发布年份 2016

来源: Springer

【 摘 要 】

Bowel endoscopy referrals from primary care have increased steadily over recent years. However, most patients do not have significant colorectal disease (SCD). Therefore, strategies to select those who would benefit most from endoscopy are of current interest. A recent study developed a multivariable diagnostic model for SCD with routine clinical information, extended with quantitative faecal calprotectin (f-C) point-of-care (POC) testing and/or qualitative POC faecal immunochemical test (FIT) for haemoglobin (f-Hb) results. This study used POC tests for both f-C and f-Hb; however, POC tests have many disadvantages and there are several reasons why quantitative measurements of f-Hb are advantageous. Quantitative faecal immunochemical tests have been used very successfully in triage of patients presenting in primary care as a rule-out test. Studies have compared f-C and f-Hb in this clinical context and consider that f-C is not required in diagnosis. A single quantitative f-Hb result, without any clinical information, could be sufficient to decide whom to refer for endoscopy and, because of the significant overlap of symptoms in those with and without SCD, could be the primary investigation performed.Please see related article: http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0684-5.

【 授权许可】

CC BY   
© The Author(s). 2016