Assessment of disease activity by fecal occult blood test in inflammatory bowel disease

OBJECTIVES: The disease activity and disease localization are important parameters at the treatment decision of inflammatory bowel disease (IBD). Clinical activity indices, laboratory, endoscopic and histopathological examinations are used to evaluate disease activity. Although endoscopic and histopathological investigations are the most reliable, they are invasive and costly. C-Reactive protein (CRP), erythrocyte sedimentation rate (ESR) and fecal calprotectin (FC) are used as laboratory tests. However, fecal calprotectin is a costly study that cannot be examined in every center in our country. As a cost-effective, easily applicable, non-invasive stool test, we aimed to evaluate the clinical activation in IBD patients by using fecal occult blood (FOB) test. MATERIAL AND METHOD: This study included 115 patients with IBD between the ages of 18-80 (44 male, 71 female, mean age: 48.04 ± 13.5 years, 59 patients with Crohn's Disease (CD), 56 with Ulcerative Colitis (UC)). The diagnosis of IBD was made by evaluating all clinical, endoscopic, histopathological and radiological findings. Harvey Bradshaw Index (remission≤4) and Modified Mayo Scoring (remission ≤2) were used to assess the clinical activity of CD and UC. Simultaneously, FOBT was investigated (HM-Jack fecal occult autoanalyzer) in all patients however endoscopic activation status was investigated only in 59 of 115 patients. RESULTS: 17/56 (30.4%) of UC and 15/59 (25.4%) of CD patients were an active disease. (Mean Modified Mayo Score: 1.71 ± 2.11, Mean Harvey Bradshaw Index score: 2.81 ± 2.24) While there was a significant correlation between FOBT positivity in the UC group during the activation period (p = 0.009) and no significant difference was found in the CD group (p = 0.189). When compared with clinical activation, the FOBT; sensitivity, specificity, positive predictive value, and negative predictive values were calculated as 84.37 %, 45.78 %, 37.50 %, and 88.37 %, respectively. Endoscopies of 59/115 patients (UC 32/56 and CH 27/59) were examined. In comparison with the endoscopic activation status, the sensitivity, specificity, positive predictive value, and negative predictive values were 79.06 %, 62.5 %, 85.0 %, and 52.63 %, respectively. CONCLUSION: Our study showed that FOBT may be useful in assessing disease activity as a rapid, easily applicable and cost-effective marker in patients with IBD. Keywords: Inflammatory Bowel Disease, Fecal Occult Blood Test, Disease Activation