| Summary: | Gastrointestinal (GI) bleeding can be a common cause of hospitalization, particularly in elderly patients.1 GI bleeding can be overt (where the patient and physician can detect the presence of blood without testing), occult (where there are symptoms of bleeding such as anemia, but that a test is needed to confirm bleeding), or obscure (where the bleeding or source of bleeding is not identified despite invasive testing).2 Occult bleeding is often caused by colorectal cancer (CRC) lesions whereas other bleeding could be caused by small bowel diseases or upper GI conditions.1,3 One commonly accepted method to screen for CRC is the fecal occult blood test (FOBT).4 FOBT may be guaiac-based (gFOBT) or immunochemical (iFOBT or FIT). Guaiac-based FOBT detects hemoglobin by the presence of a peroxidase reaction. Immunochemical tests use antibodies to detect the globulin portion of human hemoglobin.5 FOBT is known to be effective in detecting colorectal lesions3 by identifying occult blood in the stool. It is not well known, however, whether or not FOBT is effective in identifying other gastrointestinal bleeding.3 In fact, FOBT is validated for use in asymptomatic patients for CRC screening and has generally not been recommended for use in symptomatic patients.6 Despite being generally recommended for screening use, a survey of Canadian gastroenterologists and specialists in the Winnipeg Regional Health Authority showed that FOBT was commonly ordered in hospitalized patients with black stools and anemia with or without iron deficiency.7 This review seeks to determine the clinical effectiveness of urgent non-screening FOBT for hospitalized patients with suspected GI bleeding and to identify relevant evidence-based guidelines for the use of FOBT in those patients
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