Accuracy of faecal occult blood test and Helicobacter pylori stool antigen test for detection of upper gastrointestinal lesions

Yi Chia Lee, Han Mo Chiu, Tsung Hsien Chiang, Amy Ming Fang Yen, Sherry Yueh Hsia Chiu, Sam Li Sheng Chen, Jean Ching Yuan Fann, Yen Po Yeh, Chao Sheng Liao, Tsung Hui Hu, Chia Hung Tu, Ping Huei Tseng, Chien Chuan Chen, Mei Jyh Chen, Jyh Ming Liou, Wei Chih Liao, Yo Ping Lai, Chen Ping Wang, Jenq Yuh Ko, Hsiu Po WangHung Chiang, Jaw Town Lin, Hsiu Hsi Chen, Ming Shiang Wu

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objective: Highly sensitive guaiac-based faecal occult blood (Hemoccult SENSA) and Helicobacter pylori stool antigen testing might help detect upper gastrointestinal lesions when appended to a colorectal cancer screening programme with faecal immunochemical testing. We evaluated the diagnostic accuracies of two stool tests in detecting upper gastrointestinal lesions. Design: Cross-sectional design. Setting: Hospital-based and community-based screening settings. Participants: A hospital-based deviation cohort of 3172 participants to evaluate test performance and a community-based validation cohort of 3621 to verify the findings. Interventions: Three types of stool tests with bidirectional endoscopy as the reference standard. Outcomes: Sensitivity, specificity and positive and negative likelihood ratios. Results: For detecting upper gastrointestinal lesions in cases with negative immunochemical tests, the sensitivity, specificity, and positive and negative likelihood ratios of the guaiac-based and H pylori antigen tests were 16.3% (95% CI 13.3% to 19.8%), 90.1% (88.9% to 91.2%), 1.64 (1.31 to 2.07), and 0.93 (0.89 to 0.97), respectively, and 52.5% (48.1% to 56.9%), 80.6% (79.0% to 82.1%), 2.71 (2.41 to 3.04) and 0.59 (0.54 to 0.65), respectively. For detecting upper gastrointestinal lesions in cases with normal colonoscopy, the results of the guaiac-based and H pylori antigen tests were 17.9% (14.8% to 21.5%), 90.1% (88.9% to 91.2%), 1.81 (1.45 to 2.26) and 0.91 (0.87 to 0.95), respectively, and 53.1% (48.6% to 57.4%), 80.7% (79.1% to 82.2%), 2.75 (2.45 to 3.08) and 0.58 (0.53 to 0.64), respectively. Within the community, positive predictive values of the immunochemical and H pylori antigen tests were 36.0% (26.0% to 46.0%) and 31.9% (28.3% to 35.5%), respectively, for detecting lower and upper gastrointestinal lesions, which were similar to expected values. Conclusions: The H pylori stool antigen test is more accurate than the guaiac-based test in the screening of upper gastrointestinal lesions in a population with high prevalence of H pylori infection and upper gastrointestinal lesions. It is applicable to add the H pylori antigen test to the immunochemical test for pan detection. Trial registration: NCT01341197 (ClinicalTrial.gov).

Original languageEnglish
Article numbere003989
JournalBMJ Open
Volume3
Issue number10
DOIs
Publication statusPublished - 2013

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Occult Blood
Pylorus
Hematologic Tests
Guaiac
Helicobacter pylori
Antigens
Sensitivity and Specificity
Colonoscopy
Early Detection of Cancer
Endoscopy
Colorectal Neoplasms
H antigen
Infection
Population

ASJC Scopus subject areas

  • Medicine(all)

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Accuracy of faecal occult blood test and Helicobacter pylori stool antigen test for detection of upper gastrointestinal lesions. / Lee, Yi Chia; Chiu, Han Mo; Chiang, Tsung Hsien; Yen, Amy Ming Fang; Chiu, Sherry Yueh Hsia; Chen, Sam Li Sheng; Fann, Jean Ching Yuan; Yeh, Yen Po; Liao, Chao Sheng; Hu, Tsung Hui; Tu, Chia Hung; Tseng, Ping Huei; Chen, Chien Chuan; Chen, Mei Jyh; Liou, Jyh Ming; Liao, Wei Chih; Lai, Yo Ping; Wang, Chen Ping; Ko, Jenq Yuh; Wang, Hsiu Po; Chiang, Hung; Lin, Jaw Town; Chen, Hsiu Hsi; Wu, Ming Shiang.

In: BMJ Open, Vol. 3, No. 10, e003989, 2013.

Research output: Contribution to journalArticle

Lee, YC, Chiu, HM, Chiang, TH, Yen, AMF, Chiu, SYH, Chen, SLS, Fann, JCY, Yeh, YP, Liao, CS, Hu, TH, Tu, CH, Tseng, PH, Chen, CC, Chen, MJ, Liou, JM, Liao, WC, Lai, YP, Wang, CP, Ko, JY, Wang, HP, Chiang, H, Lin, JT, Chen, HH & Wu, MS 2013, 'Accuracy of faecal occult blood test and Helicobacter pylori stool antigen test for detection of upper gastrointestinal lesions', BMJ Open, vol. 3, no. 10, e003989. https://doi.org/10.1136/bmjopen-2013-003989
Lee, Yi Chia ; Chiu, Han Mo ; Chiang, Tsung Hsien ; Yen, Amy Ming Fang ; Chiu, Sherry Yueh Hsia ; Chen, Sam Li Sheng ; Fann, Jean Ching Yuan ; Yeh, Yen Po ; Liao, Chao Sheng ; Hu, Tsung Hui ; Tu, Chia Hung ; Tseng, Ping Huei ; Chen, Chien Chuan ; Chen, Mei Jyh ; Liou, Jyh Ming ; Liao, Wei Chih ; Lai, Yo Ping ; Wang, Chen Ping ; Ko, Jenq Yuh ; Wang, Hsiu Po ; Chiang, Hung ; Lin, Jaw Town ; Chen, Hsiu Hsi ; Wu, Ming Shiang. / Accuracy of faecal occult blood test and Helicobacter pylori stool antigen test for detection of upper gastrointestinal lesions. In: BMJ Open. 2013 ; Vol. 3, No. 10.
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title = "Accuracy of faecal occult blood test and Helicobacter pylori stool antigen test for detection of upper gastrointestinal lesions",
abstract = "Objective: Highly sensitive guaiac-based faecal occult blood (Hemoccult SENSA) and Helicobacter pylori stool antigen testing might help detect upper gastrointestinal lesions when appended to a colorectal cancer screening programme with faecal immunochemical testing. We evaluated the diagnostic accuracies of two stool tests in detecting upper gastrointestinal lesions. Design: Cross-sectional design. Setting: Hospital-based and community-based screening settings. Participants: A hospital-based deviation cohort of 3172 participants to evaluate test performance and a community-based validation cohort of 3621 to verify the findings. Interventions: Three types of stool tests with bidirectional endoscopy as the reference standard. Outcomes: Sensitivity, specificity and positive and negative likelihood ratios. Results: For detecting upper gastrointestinal lesions in cases with negative immunochemical tests, the sensitivity, specificity, and positive and negative likelihood ratios of the guaiac-based and H pylori antigen tests were 16.3{\%} (95{\%} CI 13.3{\%} to 19.8{\%}), 90.1{\%} (88.9{\%} to 91.2{\%}), 1.64 (1.31 to 2.07), and 0.93 (0.89 to 0.97), respectively, and 52.5{\%} (48.1{\%} to 56.9{\%}), 80.6{\%} (79.0{\%} to 82.1{\%}), 2.71 (2.41 to 3.04) and 0.59 (0.54 to 0.65), respectively. For detecting upper gastrointestinal lesions in cases with normal colonoscopy, the results of the guaiac-based and H pylori antigen tests were 17.9{\%} (14.8{\%} to 21.5{\%}), 90.1{\%} (88.9{\%} to 91.2{\%}), 1.81 (1.45 to 2.26) and 0.91 (0.87 to 0.95), respectively, and 53.1{\%} (48.6{\%} to 57.4{\%}), 80.7{\%} (79.1{\%} to 82.2{\%}), 2.75 (2.45 to 3.08) and 0.58 (0.53 to 0.64), respectively. Within the community, positive predictive values of the immunochemical and H pylori antigen tests were 36.0{\%} (26.0{\%} to 46.0{\%}) and 31.9{\%} (28.3{\%} to 35.5{\%}), respectively, for detecting lower and upper gastrointestinal lesions, which were similar to expected values. Conclusions: The H pylori stool antigen test is more accurate than the guaiac-based test in the screening of upper gastrointestinal lesions in a population with high prevalence of H pylori infection and upper gastrointestinal lesions. It is applicable to add the H pylori antigen test to the immunochemical test for pan detection. Trial registration: NCT01341197 (ClinicalTrial.gov).",
author = "Lee, {Yi Chia} and Chiu, {Han Mo} and Chiang, {Tsung Hsien} and Yen, {Amy Ming Fang} and Chiu, {Sherry Yueh Hsia} and Chen, {Sam Li Sheng} and Fann, {Jean Ching Yuan} and Yeh, {Yen Po} and Liao, {Chao Sheng} and Hu, {Tsung Hui} and Tu, {Chia Hung} and Tseng, {Ping Huei} and Chen, {Chien Chuan} and Chen, {Mei Jyh} and Liou, {Jyh Ming} and Liao, {Wei Chih} and Lai, {Yo Ping} and Wang, {Chen Ping} and Ko, {Jenq Yuh} and Wang, {Hsiu Po} and Hung Chiang and Lin, {Jaw Town} and Chen, {Hsiu Hsi} and Wu, {Ming Shiang}",
year = "2013",
doi = "10.1136/bmjopen-2013-003989",
language = "English",
volume = "3",
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TY - JOUR

T1 - Accuracy of faecal occult blood test and Helicobacter pylori stool antigen test for detection of upper gastrointestinal lesions

AU - Lee, Yi Chia

AU - Chiu, Han Mo

AU - Chiang, Tsung Hsien

AU - Yen, Amy Ming Fang

AU - Chiu, Sherry Yueh Hsia

AU - Chen, Sam Li Sheng

AU - Fann, Jean Ching Yuan

AU - Yeh, Yen Po

AU - Liao, Chao Sheng

AU - Hu, Tsung Hui

AU - Tu, Chia Hung

AU - Tseng, Ping Huei

AU - Chen, Chien Chuan

AU - Chen, Mei Jyh

AU - Liou, Jyh Ming

AU - Liao, Wei Chih

AU - Lai, Yo Ping

AU - Wang, Chen Ping

AU - Ko, Jenq Yuh

AU - Wang, Hsiu Po

AU - Chiang, Hung

AU - Lin, Jaw Town

AU - Chen, Hsiu Hsi

AU - Wu, Ming Shiang

PY - 2013

Y1 - 2013

N2 - Objective: Highly sensitive guaiac-based faecal occult blood (Hemoccult SENSA) and Helicobacter pylori stool antigen testing might help detect upper gastrointestinal lesions when appended to a colorectal cancer screening programme with faecal immunochemical testing. We evaluated the diagnostic accuracies of two stool tests in detecting upper gastrointestinal lesions. Design: Cross-sectional design. Setting: Hospital-based and community-based screening settings. Participants: A hospital-based deviation cohort of 3172 participants to evaluate test performance and a community-based validation cohort of 3621 to verify the findings. Interventions: Three types of stool tests with bidirectional endoscopy as the reference standard. Outcomes: Sensitivity, specificity and positive and negative likelihood ratios. Results: For detecting upper gastrointestinal lesions in cases with negative immunochemical tests, the sensitivity, specificity, and positive and negative likelihood ratios of the guaiac-based and H pylori antigen tests were 16.3% (95% CI 13.3% to 19.8%), 90.1% (88.9% to 91.2%), 1.64 (1.31 to 2.07), and 0.93 (0.89 to 0.97), respectively, and 52.5% (48.1% to 56.9%), 80.6% (79.0% to 82.1%), 2.71 (2.41 to 3.04) and 0.59 (0.54 to 0.65), respectively. For detecting upper gastrointestinal lesions in cases with normal colonoscopy, the results of the guaiac-based and H pylori antigen tests were 17.9% (14.8% to 21.5%), 90.1% (88.9% to 91.2%), 1.81 (1.45 to 2.26) and 0.91 (0.87 to 0.95), respectively, and 53.1% (48.6% to 57.4%), 80.7% (79.1% to 82.2%), 2.75 (2.45 to 3.08) and 0.58 (0.53 to 0.64), respectively. Within the community, positive predictive values of the immunochemical and H pylori antigen tests were 36.0% (26.0% to 46.0%) and 31.9% (28.3% to 35.5%), respectively, for detecting lower and upper gastrointestinal lesions, which were similar to expected values. Conclusions: The H pylori stool antigen test is more accurate than the guaiac-based test in the screening of upper gastrointestinal lesions in a population with high prevalence of H pylori infection and upper gastrointestinal lesions. It is applicable to add the H pylori antigen test to the immunochemical test for pan detection. Trial registration: NCT01341197 (ClinicalTrial.gov).

AB - Objective: Highly sensitive guaiac-based faecal occult blood (Hemoccult SENSA) and Helicobacter pylori stool antigen testing might help detect upper gastrointestinal lesions when appended to a colorectal cancer screening programme with faecal immunochemical testing. We evaluated the diagnostic accuracies of two stool tests in detecting upper gastrointestinal lesions. Design: Cross-sectional design. Setting: Hospital-based and community-based screening settings. Participants: A hospital-based deviation cohort of 3172 participants to evaluate test performance and a community-based validation cohort of 3621 to verify the findings. Interventions: Three types of stool tests with bidirectional endoscopy as the reference standard. Outcomes: Sensitivity, specificity and positive and negative likelihood ratios. Results: For detecting upper gastrointestinal lesions in cases with negative immunochemical tests, the sensitivity, specificity, and positive and negative likelihood ratios of the guaiac-based and H pylori antigen tests were 16.3% (95% CI 13.3% to 19.8%), 90.1% (88.9% to 91.2%), 1.64 (1.31 to 2.07), and 0.93 (0.89 to 0.97), respectively, and 52.5% (48.1% to 56.9%), 80.6% (79.0% to 82.1%), 2.71 (2.41 to 3.04) and 0.59 (0.54 to 0.65), respectively. For detecting upper gastrointestinal lesions in cases with normal colonoscopy, the results of the guaiac-based and H pylori antigen tests were 17.9% (14.8% to 21.5%), 90.1% (88.9% to 91.2%), 1.81 (1.45 to 2.26) and 0.91 (0.87 to 0.95), respectively, and 53.1% (48.6% to 57.4%), 80.7% (79.1% to 82.2%), 2.75 (2.45 to 3.08) and 0.58 (0.53 to 0.64), respectively. Within the community, positive predictive values of the immunochemical and H pylori antigen tests were 36.0% (26.0% to 46.0%) and 31.9% (28.3% to 35.5%), respectively, for detecting lower and upper gastrointestinal lesions, which were similar to expected values. Conclusions: The H pylori stool antigen test is more accurate than the guaiac-based test in the screening of upper gastrointestinal lesions in a population with high prevalence of H pylori infection and upper gastrointestinal lesions. It is applicable to add the H pylori antigen test to the immunochemical test for pan detection. Trial registration: NCT01341197 (ClinicalTrial.gov).

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