BMJ Open Gastroenterology最新文献

{"title":"Mpox gastrointestinal manifestations: a systematic review.","authors":"Rahul Ramakrishnan, Atira Shenoy, Ranganathan Madhavan, Damon Meyer","doi":"10.1136/bmjgast-2023-001266","DOIUrl":"10.1136/bmjgast-2023-001266","url":null,"abstract":"<p><strong>Introduction: </strong>Mpox is a viral infection caused by the monkeypox virus, a member of the Poxviridae family and Orthopoxvirus genus. Other well-known viruses of the Orthopoxvirus genus include the variola virus (smallpox), cowpox virus and vaccinia virus. Although there is a plethora of research regarding the dermatological and influenza-like symptoms of mpox, particularly following the 2022 mpox outbreak, more research is needed on the gastrointestinal (GI) effects.</p><p><strong>Objectives: </strong>This systematic review is to outline the GI manifestations of the monkeypox virus.</p><p><strong>Methods: </strong>The authors conducted this systematic review using guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A search was conducted through the PubMed, EMBASE and MEDLINE databases from January 1958 to June 2023. The authors selected English language papers that discussed the GI symptoms in mpox patients. A manual search was also conducted in the reference sections of these publications for other relevant papers.</p><p><strong>Results: </strong>33 papers involving 830 patients were selected for this review. The GI manifestations in mpox patients are proctitis, vomiting, diarrhoea, rectal pain, nausea, tenesmus, rectal bleeding and abdominal pain. Although various papers explored transmission routes, one paper established a direct connection between anal-receptive sex transmission route and the development of a GI complication (proctitis). Another study reported that the mode of transmission could potentially impact the occurrence of GI symptoms and severity of the disease. The reviewed papers did not discover a relation between the severity of dermatological and influenza-like symptoms and the GI manifestations mentioned.</p><p><strong>Conclusion: </strong>This systematic review confirms that GI manifestations are observed in mpox patients. GI symptoms of mpox are crucial for gastroenterologists and other healthcare professionals to recognise in order to address patient discomfort and further understand the pathophysiology of the virus.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"11 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773419/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139110820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigating the role of iron status in the development of coeliac disease: a Mendelian randomisation study.","authors":"Isabel A Hujoel, Margaux Louise Anna Hujoel","doi":"10.1136/bmjgast-2023-001236","DOIUrl":"10.1136/bmjgast-2023-001236","url":null,"abstract":"<p><strong>Objective: </strong>The environmental trigger behind the increasing prevalence of coeliac disease is not known. One suggested cause is iron deficiency, which is common in coeliac disease. We aimed to evaluate this possible association with Mendelian randomisation (MR), which under certain assumptions can suggest a causal relationship.</p><p><strong>Design: </strong>We conducted a two-sample MR study examining the relationship between single nucleotide polymorphisms (SNPs) associated with iron status and the presence of coeliac disease. The SNPs were drawn from a meta-analysis of three genome-wide association studies (GWAS). The association between these SNPs and coeliac disease was assessed using GWAS summary statistics from the UK Biobank. This consists of 336 638 white British individuals, 1855 with coeliac disease. We performed an MR Egger test for pleiotropy and assessed the plausibility of the assumptions of MR to evaluate for possible causality.</p><p><strong>Results: </strong>There were four SNPs strongly associated with systemic iron status. These were not associated with known risk factors for coeliac disease. All four SNPs were available in the UK Biobank coeliac disease summary statistics. Harmonising exposure and outcome associations, we found that higher iron status was negatively associated with risk of coeliac disease (OR per 1 SD increase in serum iron: 0.65, 95% CI 0.47 to 0.91). Leave-one-out analyses had consistent results, and no single SNP drove the association. All three assumptions of MR appeared plausible.</p><p><strong>Conclusion: </strong>We found that genetically lower iron levels were associated with an increased risk of coeliac disease. Our findings highlight a potential opportunity for coeliac disease prevention.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"11 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139097304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Hispanic ethnicity play a role in outcomes for diverticular surgery in the USA?","authors":"Jesse K Kelley, Kathrine Kelly, Charles Reed, Nathan Winkler, Jessica Parker, James Ogilvie","doi":"10.1136/bmjgast-2023-001215","DOIUrl":"10.1136/bmjgast-2023-001215","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to investigate whether origins of ethnicity affect the outcomes of surgery for diverticulitis in the USA.</p><p><strong>Design: </strong>The American College of Surgeons National Surgical Quality Improvement Programme database from 2008 to 2017 was used to identify patients undergoing colectomy for diverticulitis. Patient demographics, comorbidities, procedural details and outcomes were captured and compared by ethnicity status.</p><p><strong>Results: </strong>A total of 375 311 surgeries for diverticulitis were included in the final analysis. The average age of patients undergoing surgery for diverticulitis remained consistent over the time frame of the study (62 years), although the percentage of younger patients (age 18-39 years) rose slightly from 7.8% in 2008 to 8.6% in 2017. The percentage of surgical patients with Hispanic ethnicity increased from 3.7% in 2008 to 6.6% of patients in 2017. Hispanic patients were younger than their non-Hispanic counterparts (57 years vs 62 years, p<0.01) at time of surgery. There were statistically significant differences in the proportion of laparoscopic cases (51% vs 49%, p<0.01), elective cases (62% vs 66%, p<0.01) and the unadjusted rate of postoperative mortality (2.8% vs 3.4%, p<0.01) between Hispanic patients compared with non-Hispanic patients, respectively. Multivariable logistic regression models did not identify Hispanic ethnicity as a significant predictor for increased morbidity (p=0.13) or mortality (p=0.80).</p><p><strong>Conclusion: </strong>Despite a significant younger population undergoing surgery for diverticulitis, Hispanic ethnicity was not associated with increased rates of emergent surgery, open surgery or postoperative complications compared with a similar non-Hispanic population.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"10 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10693875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138482028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Naturally nutrient rich (NNR) score and the risk of colorectal cancer: a case-control study.","authors":"Naeemeh Hassanpour Ardekanizadeh, Mahdi Mousavi Mele, Saeideh Mohammadi, Soheila Shekari, Mobina Zeinalabedini, Mohammad Masoumvand, Seyedeh Hayedeh Mousavi Shalmani, Seyed Ali Askarpour, Maryam Gholamalizadeh, Farhad Vahid, Saeid Doaei","doi":"10.1136/bmjgast-2023-001242","DOIUrl":"10.1136/bmjgast-2023-001242","url":null,"abstract":"<p><strong>Background: </strong>The association between colorectal cancer (CRC) and nutrients has been studied frequently. However, the association of nutrient density of diets with the risk of CRC has been less studied. This study aimed to investigate the association between CRC and naturally nutrient rich (NNR) score in Iranian adults.</p><p><strong>Method: </strong>This case-control study included 160 patients with colorectal cancer and 320 controls aged 35-70 years in Tehran, Iran. Dietary intake was assessed using a 168-item food frequency questionnaire. The NNR score was obtained by calculating the average daily value of 14 nutrients including protein, vitamins A, C, D, E, B₁, B₂, B₁₂, calcium, zinc, iron, folate, potassium and unsaturated fatty acids.</p><p><strong>Results: </strong>Regarding dietary intake of the components of NNR score, the case group had a lower intake of polyunsaturated fat (15.41±4.44 vs 16.54±4.20 g/day, p=0.01), vitamin E (10.15±4.16 vs 13.1±5.33; p=0.001), vitamin B₁ (2±0.86 vs 2.19±0.84 mg/day, p=0.03) and folate (516.45±96.59 vs 571.05±80.31; p=0.001) and a higher intake of oleic acid (8.21±5.46 vs 5.59±3.17 g/day, p=0.01) compared with the control group. Colorectal cancer risk was inversely associated with the NNR score after adjusting for the confounders (OR 0.92; 95% CI 0.88 to 0.97; p=0.03).</p><p><strong>Conclusion: </strong>Low NNR scores may be linked to CRC. If confirmed by future longitudinal research, this result may help prevent CRC by recommending nutrient-rich diets.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"10 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10693883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138482029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"People with IBD evidence more microarousals during sleep architecture assessments","authors":"Jessica K Salwen-Deremer, Matthew J Reid, Sarah J Westvold, Corey A Siegel, Michael T Smith","doi":"10.1136/bmjgast-2023-001249","DOIUrl":"https://doi.org/10.1136/bmjgast-2023-001249","url":null,"abstract":"Objective Poor sleep is common in inflammatory bowel disease (IBD) and may be associated with overall worse disease outcomes. While the sleep/IBD literature is growing, the data are often self-reported. Further, much of the research using objective measures of sleep architecture, or the overall pattern of sleep depth, rely on single-night assessments, which can be of questionable validity. Design Participants with IBD and healthy controls were recruited from Dartmouth-Hitchcock Medical Center as part of a two-phase clinical trial. Sleep architecture was assessed using three nights of in-home electroencephalographic monitoring and scored according to the American Academy of Sleep Medicine guidelines. Results Our sample included 15 participants with IBD and 8 healthy controls. Participants with IBD were more psychiatrically complex, with more self-reported insomnia, anxiety and depression. Participants with IBD evidenced greater microarousals than healthy controls. In participants with IBD, microarousals were associated with lower insomnia and greater depression scores. Within IBD, participants with clinically significant insomnia evidenced trend towards lower sleep efficiency, while self-reported disease activity did not significantly impact findings. Conclusions The methodology of past research may have impacted findings, including the reliance on single-night assessments and limited generalisability. Future research that uses robust, multinight assessments of sleep architecture in large, diverse samples is clearly warranted, as is research exploring the impact of cognitive and behavioural factors on sleep architecture and arousal. Trial registration number [NCT04132024][1]. The data underlying this article cannot be shared publicly due to the privacy of individuals that participated in the study. The data will be shared on reasonable request to the corresponding author. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT04132024&atom=%2Fbmjgast%2F10%2F1%2Fe001249.atom","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"19 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139056595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of artificial intelligence in imaging and endoscopy for the diagnosis, monitoring and prognostication of inflammatory bowel disease: a scoping review protocol","authors":"Mallory Chavannes, Lynn Kysh, Mariangela Allocca, Noa Krugliak Cleveland, Michael Todd Dolinger, Tom S Robbins, David T Rubin, Shintaro Sagami, Bram Verstockt, Kerri Novak","doi":"10.1136/bmjgast-2023-001182","DOIUrl":"https://doi.org/10.1136/bmjgast-2023-001182","url":null,"abstract":"Introduction Inflammatory bowel diseases (IBD) are immune-mediated conditions that are increasing in incidence and prevalence worldwide. Their assessment and monitoring are becoming increasingly important, though complex. The best disease control is achieved through tight monitoring of objective inflammatory parameters (such as serum and stool inflammatory markers), cross-sectional imaging and endoscopic assessment. Considering the complexity of the information obtained throughout a patient’s journey, artificial intelligence (AI) provides an ideal adjunct to existing tools to help diagnose, monitor and predict the course of disease of patients with IBD. Therefore, we propose a scoping review assessing AI’s role in diagnosis, monitoring and prognostication tools in patients with IBD. We aim to detect gaps in the literature and address them in future research endeavours. Methods and analysis We will search electronic databases, including Medline, Embase, Cochrane CENTRAL, CINAHL Complete, Web of Science and IEEE Xplore. Two reviewers will independently screen the abstracts and titles first and then perform the full-text review. A third reviewer will resolve any conflict. We will include both observational studies and clinical trials. Study characteristics will be extracted using a data extraction form. The extracted data will be summarised in a tabular format, following the imaging modality theme and the study outcome assessed. The results will have an accompanying narrative review. Ethics and dissemination Considering the nature of the project, ethical review by an institutional review board is not required. The data will be presented at academic conferences, and the final product will be published in a peer-reviewed journal. No data are available.","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"196 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138572163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progression of the FIB-4 index among patients with chronic HCV infection and early liver disease","authors":"Lisette A P Krassenburg, Raoel Maan, Amy Puenpatom, Nicole S Erler, Christoph Welsch, Stijn van Hees, Orlando Cerrhoci, Johannes Vermehren, Robert J de Knegt, Bettina E Hansen, Stefan Zeuzem, Thomas Vanwolleghem, Harry L A Janssen, Robert A de Man, Jordan J Feld, Adriaan J van der Meer","doi":"10.1136/bmjgast-2023-001209","DOIUrl":"https://doi.org/10.1136/bmjgast-2023-001209","url":null,"abstract":"Background and aims Historical paired liver biopsy studies are likely to underestimate current progression of disease in patients with chronic hepatitis C virus (HCV) infection. We aimed to assess liver disease progression according to the non-invasive Fibrosis-4 (FIB-4) index in patients with chronic HCV and early disease. Methods and results Patients diagnosed with chronic HCV and FIB-4 <3.25 from four international liver clinics were included in a retrospective cohort study. Follow-up ended at start of antiviral therapy resulting in sustained virological response, at time of liver transplantation or death. Primary outcome of advanced liver disease was defined as FIB-4 >3.25 during follow-up. Survival analyses were used to assess time to FIB-4 >3.25. In total, 4286 patients were followed for a median of 5.0 (IQR 1.7–9.4) years, during which 41 071 FIB-4 measurements were collected. At baseline, median age was 47 (IQR 39–55) years, 2529 (59.0%) were male, and 2787 (65.0%) patients had a FIB-4 <1.45. Advanced liver disease developed in 821 patients. Overall, 10-year cumulative incidence of advanced disease was 32.1% (95% CI 29.9% to 34.3%). Patients who developed advanced disease showed an exponential FIB-4 increase. Among patients with a presumed date of HCV infection, cumulative incidence of advanced disease increased 7.7-fold from 20 to 40 years as opposed to the first 20 years after HCV infection. Conclusions The rate of advanced liver disease is high among chronic HCV-infected patients with early disease at time of diagnosis, among whom liver disease progression accelerated over time. These results emphasise the need to overcome any limitations with respect to diagnosing and treating all patients with chronic HCV across the globe. Data are available upon reasonable request.","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"3 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138554832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications of colonoscopy: common and rare—recognition, assessment and management","authors":"William Waddingham, Umair Kamran, Bhaskar Kumar, Nigel J Trudgill, Zacharias P Tsiamoulos, Matthew Banks","doi":"10.1136/bmjgast-2023-001193","DOIUrl":"https://doi.org/10.1136/bmjgast-2023-001193","url":null,"abstract":"An understanding of the potential complications of diagnostic lower gastrointestinal endoscopy is a necessary part of being an independent endoscopist. Creating a culture of safety and prevention of adverse events (AEs) should be part of routine endoscopy practice. Appropriate patient selection for procedures, informed consent, peri-procedure risk assessments and an inclusive team approach, all contribute to preventing AEs. Early recognition, prompt management and transparent communication with patients are essential for the holistic and optimal management of AEs. In this review, we discuss the complications of diagnostic lower gastro-intestinal endoscopy, including their recognition, treatment and prevention.","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"12 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138554560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating clinical outcomes and prognosis in patients with cirrhosis and portal hypertension: a retrospective observational cohort study.","authors":"Nerissa Hoi Ching Lee, Steven J Kiddle, Shardul Chandankhede, Shubh Agrawal, Daniel M Bean, Phillip R Hunt, Victoria E R Parker, Peter J Greasley, Philip Ambery","doi":"10.1136/bmjgast-2023-001234","DOIUrl":"10.1136/bmjgast-2023-001234","url":null,"abstract":"<p><strong>Objective: </strong>Cirrhosis describes the end-stage of chronic liver disease. Irreversible changes in the liver cause portal hypertension, which can progress to serious complications and death. Only a few studies with small sample sizes have investigated the prognosis of cirrhosis with portal hypertension. We used electronic healthcare records to examine liver-related outcomes in patients with diagnosed/suspected portal hypertension.</p><p><strong>Design: </strong>This retrospective observational cohort study used secondary health data between 1 January 2017 and 3 December 2020 from the TriNetX Network, a federated electronic healthcare records platform. Three patient groups with cirrhosis and diagnosed/suspected portal hypertension were identified ('most severe', 'moderate severity' and 'least severe'). Outcomes studied individually and as a composite were variceal haemorrhage, hepatic encephalopathy, complications of ascites and recorded mortality up to 24 months.</p><p><strong>Results: </strong>There were 13 444, 23 299, and 23 836 patients in the most severe, moderate severity and least severe groups, respectively. Mean age was similar across groups; most participants were white. The most common individual outcomes at 24 months were variceal haemorrhage in the most severe group, recorded mortality and hepatic encephalopathy in the moderate severity group, and recorded mortality in the least severe group. Recorded mortality rate was similar across groups. For the composite outcome, cumulative incidence was 59% in the most severe group at 6 months. Alcohol-associated liver disease and metabolic-associated steatohepatitis were significantly associated with the composite outcome across groups.</p><p><strong>Conclusion: </strong>Our analysis of a large dataset from electronic healthcare records illustrates the poor prognosis of patients with diagnosed/suspected portal hypertension.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"10 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10689413/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138457896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interval colorectal cancers after negative faecal immunochemical test in the New Zealand Bowel Screening Pilot.","authors":"Kai Sheng Saw, Kerry Sexton, Paul Frankish, Mike Hulme-Moir, Ian Bissett, Susan Parry","doi":"10.1136/bmjgast-2023-001233","DOIUrl":"10.1136/bmjgast-2023-001233","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate the diagnostic performance of faecal immunochemical test (FIT), identify risk factors for FIT-interval colorectal cancers (FIT-IC) and describe long-term outcomes of participants with colorectal cancers (CRC) in the New Zealand Bowel Screening Pilot (BSP).</p><p><strong>Design: </strong>From 2012 to 2017, the BSP offered eligible individuals, aged 50-74 years, biennial screening using a quantitative FIT with positivity threshold of 15 µg haemoglobin (Hb)/g faeces. Retrospective review of prospectively maintained data extracted from the BSP Register and New Zealand Cancer Registry identified any CRC reported in participants who returned a definitive FIT result. Further details were obtained from hospital records. FIT-ICs were primary CRC diagnosed within 24 months of a negative FIT. Factors associated with FIT-ICs were identified using logistic regression.</p><p><strong>Results: </strong>Of 387 215 individuals invited, 57.4% participated with 6.1% returning positive FIT results. Final analysis included 520 CRC, of which 111 (21.3%) met FIT-IC definition. Overall FIT sensitivity for CRC was 78.7% (95% CI=74.9% to 82.1%), specificity was 94.1% (95% CI=94.0% to 94.2%). In 78 (70.3%) participants with FIT-IC, faecal Hb was reported as undetectable. There were no significant associations between FIT-IC and age, sex, ethnicity and deprivation. FIT-ICs were significantly associated with proximal tumour location, late stage at diagnosis, high-grade tumour differentiation and subsequent round screens. Median follow-up time was 74 (2-124) months. FIT-IC had significantly poorer overall survival.</p><p><strong>Conclusion: </strong>FIT sensitivity in BSP compared favourably to published data. FIT-ICs were more likely to be proximal tumours with poor long-term outcomes. Further lowering of FIT threshold would have minimal impact on FIT-IC.</p>","PeriodicalId":9235,"journal":{"name":"BMJ Open Gastroenterology","volume":"10 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2023-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10679982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138440256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}