32 J Gandhara Med Dent Sci

January - March 2025

FREQUENCY OF POSITIVE FECAL OCCULT BLOOD TEST IN PATIENTS WITH CIRRHOSIS

Faisal Khan1, Aliena Badshah2, Durkho Atif3

, Muhammad Irshad4

ABSTRACT

OBJECTIVES

The objective of this study is to determine the frequency of positive fecal

occult blood tests in patients with cirrhosis.

METHODOLOGY

This descriptive cross-sectional study had a total of 154 patients observed for

six months i.e., from 12/3/2023 to 12/9/2023 in the Department of Medicine,

Khyber Teaching Hospital, Peshawar. Patients (aged 18 -70 years) were

worked up with detailed history and clinical examination to reveal ascites,

coagulopathy, jaundice, splenomegaly, cachexia, and gynecomastia. After

having excluded the confounders, a morning fecal sample was taken under

aseptic conditions in a specialized fecal occult blood testing kit and sent for

laboratory evaluation for interpretation. The sampling technique was

consecutive non-probability. All investigations were done from the same

laboratory and under the supervision of a hematologist with three years of

fellowship experience. Data was stored and analyzed by the statistical

program IBM-SPSS version 22. Frequencies and percentages were calculated

for qualitative variables like gender, child -pugh class for cirrhosis, and

positive fecal occult blood test. Post-stratication was done through a chi-

square test and p-values <0.05 were considered as signicant.

RESULTS

In this study, the mean age was 57 years with SD ± 11.27. Sixty -two percent

of patients were males while 38% of patients were females. The mean

duration of the disease was 1 year with SD ± 3.57. More than 37% of patients

had a positive fecal occult blood test while 63% of patients had a negative

fecal occult blood test.

CONCLUSION

Our study shows that the frequency of positive fecal occult blood tests was

37% in patients with cirrhosis.

KEYWORDS: Positive, Fecal Occult Blood Test, Cirrhosis

How to cite this article

Khan F, Badshah A, Atif D, Irshad M.

Frequency of Positive Fecal Occult

Blood Test in Patients with Cirrhosis.

J Gandhara Med Dent Sci.

2024;12(1):32-35.doi:10.37762/

Date of Submission: 06-06-2024

Date Revised: 09-09-2024

Date Acceptance: 09-09-2024

1Trainee Medical Ofcer, Department of

Medicine, Khyber Teaching Hospital,

Peshawar

3Trainee Medical Officer, Department of

Medicine, Khyber Teaching Hospital,

Peshawar

4Trainee Medical Ofcer, Department of

Medicine, Khyber Teaching Hospital,

Peshawar

Correspondence

2Aliena Badshah, Assistant Professor,

Department of Medicine, Khyber

Teaching Hospital, Peshawar

+92-335-5950615

alienabadshah@yahoo.com

INTRODUCTION

Chronic liver disease (CLD) and liver cirrhosis are

clinically and pathologically dened diseases.1 The

main causes of cirrhosis of the liver include chronic

infection by viral agents (hepatitis B and C virus), as

well as metabolic, toxic/drug-induced, and autoimmune

causes, resulting in persistent inammation and

progressive brosis.2,3 Those cases that have reached

the level of cirrhosis can be noted by the following:

nerve problems, male breast growth, Dupuytren’s

contractions, hair loss, kidney failure, redness of palms,

lack of appetite, testicular shrinkage, weakness, weight

loss, itching, gallstones, and ascites.4,5 One of the

disastrous complications of liver cirrhosis is

coagulopathy and esophageal varices. When they bleed,

melena happens. Melena can lead to iron deciency

anemia and needs early detection and treatment. Fecal

occult blood testing is one such investigation to exclude

microscopic blood loss in cirrhotic patients due to either

esophageal varices or congestive gastropathy.3,6 It was

found that the frequency of positive fecal occult blood

tests was 34% in patients with cirrhosis.7 Liver cirrhosis

is a major public health problem in Pakistan.8 One

Pakistani study concluded that hepatitis C virus (HCV)

caused liver brosis and liver cirrhosis or

hepatocellular carcinoma (HCC) Furthermore; HCV

genotype 3a was more common.9 Another study

concluded that cirrhotic patients had a very poor quality

of life. Furthermore, low serum albumin and

hemoglobin, preceding history of decompensation

(upper gastrointestinal bleed and encephalopathy), etc.,

were found to be connected with underprivileged

health-related quality of life.10 Other Pakistani

researchers Ali et al observed that the prevalence of

HBV infection varied with the population residing in

dierent parts of the country. They suggested that

Afghan refugees in Pakistan, drug abusers, professional

blood donors, health care professionals, prisoners,

multiple transfused patients, patients with HCC,

psychiatric patients, general population of some

specific areas like Southern Punjab, Interior Sindh,

ORIGINAL ARTICLE

/jgmds.12-1.631

J Gandhara Med Dent Sci

January - March 2025

District Tatta, Kurram agency, Baltistan and some areas

of Lahore had very high HBV prevalence of more

than5%.11 Although fecal occult blood testing has been

studied well as a screening tool for colorectal

carcinoma, studies for fecal occult blood test positivity

in cirrhotic patients are scarce. Therefore, this study

was done to determine the local frequency of positive

fecal occult blood tests in patients with cirrhosis.

Routine fecal occult blood tests will provide important

information that will help rene clinical strategies in

our general population with cirrhosis, provided the

frequency of melena among such patients is found to be

higher.

METHODOLOGY

It was a descriptive cross-sectional study in the

Department of Medicine, Khyber Teaching Hospital,

Peshawar for a duration of six months i.e., from

12/03/2023 to 12/09/2023. The sample size was

calculated using 34% relevance of positive fecal occult

blood test, 5% margin of error and95% condence

interval under the WHO formula for sample size

determination in health studies which is given below n=

z2-pq d2, where proportion (positive fecal occult blood

test) is P=34%. With q=1-p and d=7.5% and

Confidence level = 95% and n= 154. The sampling

technique was consecutive (nonprobability) sampling.

Inclusion criteria had patients aged 18 to 70 of both

genders with liver cirrhosis >six months as per

operational denition. Child-Pugh Score was for

cirrhosis A/B/C (Annexure-II) whereas, West Haven

criteria was used for hepatic encephalopathy.12 For

exclusion criteria, a history of peptic ulcer disease,

colorectal cancer, hemophilia, or Von Willebrand’s

disease was sorted out. Patients on oral iron

supplements and those who had consumed eatables like

radish, turnip, and red meat in the preceding 72 hours

were also on the list of exclusions. All of them act as

confounders and included, would have introduced bias

in the study results. After getting approval from the

hospital ethics committee (vide letter No: 22008) to

conduct the study, data was collected from all those

patients with established liver cirrhosis presenting to

the Out-patient Department (OPD). They were admitted

for further evaluation. An informed written consent was

taken from those patients fullling the inclusion

criteria. Patients (aged 18-70 years) were worked up

with detailed history and clinical examination to reveal

ascites, coagulopathy, jaundice, splenomegaly,

cachexia, and gynecomastia. After having excluded the

confounders, a morning fecal sample was taken under

aseptic conditions in a specialized fecal occult blood

testing kit and sent for laboratory evaluation for

interpretation. All investigations were done from the

same laboratory and under the supervision of a

hematologist with three years of fellowship experience.

After interpreting the fecal occult blood test results in

the selected sample population with established

cirrhosis, data was recorded. All data including age,

gender, weight, symptoms, disease duration, severity of

cirrhosis, and fecal occult blood were recorded into a

proforma. Data was analyzed by the statistical program

IBM-SPSS version 22. All the quantitative variables

like age, disease duration, Child-Pugh score, and weight

were analyzed for mean± standard deviation.

Frequencies and percentages were calculated for

qualitative variables like gender, Child-Pugh class for

cirrhosis, and positive fecal occult blood test. A positive

fecal occult blood test was stratied among age, gender,

weight, disease duration Child-Pugh score and class,

and symptoms and signs for cirrhosis to see eect

modifiers. Post-stratication was done through a chi-

square test and p-values <0.05 were considered as

significant.

RESULTS

Table 1: Stratication of Positive Fecal Occult Blood Test W.R.T

Gender and Age Distribution (N=154)

Gender Distribution Age (Y ears) Distribution

Positive

Fecal

Occult

Blood

Male Female Positive

Fecal

Occult

Blood

30-

41-

51-

61-

Positive 35 22 Positive 3 13 20 21

Negative 60 37 Negative 5 22 34 36

Total 95 59 Total 8 35 54 57

Note: A chi-square test was applied in which the P

value was 0.9555 for gender and 0.9999 for age

distribution.

Table 2: Stratication of Positive Fecal Occult Blood Test W.R.T

BMI Distribution (N=154)

Positive Fecal Occult

Blood

≤ 22

Kg/M2

>22

Kg/M2 Total

Positive 31 26 57

Negative 54 43 97

Total 85 69 154

Note: Chi-square test was applied in which the P value

was 0.8770

Table 3: Stratication of Positive Fecal Occult Blood Test W.R.T

Duration of Disease (n=154)

Weight in kg Number (n=65) %age

Severe pre-eclampsia 22 22.68

Eclampsia 08 8.24

Abruption 09 9.27

Placenta previa 14 14.43

Prolonged labor 12 12.37

Big baby 08 8.24

Prolonged PROM 07 7.21

Multiple pregnancies 17 17.52

Total 97 100

Note: Chi-square test was applied in which the P value

was 0.9749

Frequency of Positive Fecal Occult Blood Test in Patients

34 J Gandhara Med Dent Sci

January - March 2025

Table 4: Stratication of Positive Fecal Occult Blood Test W.R.T

Child Pugh Score for Cirrhosis (n=154)

Positive Fecal

Occult Blood Grade A Grade B Grade C T otal

Positive 16 32 9 57

Negative 27 54 16 97

Total 43 86 25 154

Note: Chi-square test was applied in which the P value

was 0.9935

DISCUSSION

Both liver cirrhosis and chronic liver disease (CLD) are

clinically and pathologically dened and common

diseases.1 The main causes of cirrhosis of the liver

include chronic infection by viral agents (hepatitis B

and C virus), as well as metabolic, toxic/drug-induced,

and autoimmune causes, resulting in persistent

inammation and progressive brosis which can be

explained by the fact that chronic motivation of the

wound healing response, which is the major catalyst for

gradual buildup of extracellular matrix (ECM)

components, ultimately leads to liver cirrhosis and

hepatic failure.2,3 Those cases that have reached the

level of cirrhosis can be noted by the following: nerve

problems, male breast growth, Dupuytren's

contractions, hair loss, kidney failure, redness of palms,

lack of appetite, testicular shrinkage, weakness, weight

loss, itching, gallstones, and ascites. A fecal occult

blood test is used to identify human hemoglobin from

stool samples of patients by using antibodies.13 While,

it is highly eective in discovering blood from patients

with gastrointestinal lesions, such as carcinomas and

polyps, it has an excessive rate of false positive

results.14 Liver cirrhosis-aected individuals eventually

cultivate upper gastrointestinal hemorrhage due to

dierent reasons, including portal hypertension and

gastropathy.15 This blood can pass on to the lower

gastrointestinal pathways and be detected in stool,

hence this formed a basis for performing fecal occult

blood tests among liver cirrhosis patients in this study.

In this current study, the mean age was 57 years with

SD ± 11.27. Sixty-two percent of patients were male

while 38% of patients were female. The frequency of

positive fecal occult blood tests was 37% in patients

with cirrhosis. Similar results were observed in another

study in which the frequency of positive fecal occult

blood tests was 34% in patients with cirrhosis.16

Another study reported that positive FOBT found a

higher yield of abnormal lesions for EGD than for

colonoscopy (24% to 36% versus 13% to 26%,

respectively.17 In a study reported that the frequency of

positive fecal occult blood tests was 36% in patients

with cirrhosis.18 Another study reported that a positive

fecal occult blood test was found in 38% presenting

with liver cirrhosis.19 Ultimately, the decision to

perform fecal occult blood tests or other diagnostic tests

in liver cirrhosis patients should be individualized

based on clinical judgment, patient-specic factors, and

the presence of signs or symptoms suggesting

gastrointestinal bleeding.

LIMITATIONS

The study was a single-center study. Extrapolating the

findings of a single-centered study to the whole local

population might not be truly depictive of the trend of

fecal occult blood positivity in the region. Hence, multi-

centered studies highlight the correlation of fecal occult

blood results with endoscopy ndings and any

interventions will prove to be more convincing and

promising in the future.

CONCLUSIONS

Our study shows that the frequency of positive fecal

occult blood tests was 37% in patients with cirrhosis.

CONFLICT OF INTEREST: None

FUNDING SOURCES: None

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CONTRIBUTORS

1. Faisal Khan - Concept & Design; Data Acquisition; Drafting

Manuscript; Critical Revision

2. Aliena Badshah - Drafting Manuscript; Critical Revision;

Supervision; Final Approval

3. Durkho Atif - Drafting Manuscript; Critical Revision

4. Muhammad Irshad - Data Acquisition; Data

Analysis/Interpretation

Frequency of Positive Fecal Occult Blood Test in Patients