title: Is esophagogastroduodenoscopy necessary in patients with positive fecal occult blood tests and negative colonoscopy?
abstract: BACKGROUND
  False positives of fecal occult blood tests (FOBT) regarding colorectal cancer detection are common. The aim was to investigate the upper gastrointestinal (GI) condition confirmed by endoscopy in positive FOBT patients without advanced colorectal neoplasia, hemorrhoid, or colitis.
  
  
  METHODS
  The authors reviewed the collective data of 340 positive FOBT patients who underwent both esophagogastroduodenoscopy (EGD) and colonoscopy from January 2005 to October 2011. Demographic data, effects of medications, including antiplatelet agents, nonsteroidal anti-inflammatory drugs, or warfarin on the results of FOBT, presence or absence of GI mucosal lesions confirmed by EGD and colonoscopy, and FOBT titer in 552 positive FOBT patients were analyzed.
  
  
  RESULTS
  On colonoscopy, colorectal cancer was detected in 35 patients (10.3%), advanced adenoma in 22 patients (6.4%). "Negative colonoscopy" included no significant lesions and non-advanced adenomas. In 243 patients with "negative colonoscopy", EGD findings included 3 (1.2%) gastric cancers and 39 (16%) peptic ulcer diseases. Gastric cancers were all found in patients who had no experience of EGD within 2 years; however, the incidence of peptic ulcer disease was not different in patients with or without previous EGD within 2 years. Two or more antiplatelet agents increased false positive rates of FOBT.
  
  
  CONCLUSIONS
  Upper GI evaluation is mandatory in patients with positive FOBTs and negative colonoscopy especially in patients without experience of EGD within 2 years.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, Kwandong University College of Medicine, Myongji Hospital, Goyang, South Korea.
authors.forename: Ja Sung
authors.initials: JS
authors.lastname: Choi
authors.forename: Jin Yi
authors.initials: JY
authors.lastname: Choi
authors.forename: Hyeon Geun
authors.initials: HG
authors.lastname: Cho
authors.forename: Ki Jun
authors.initials: KJ
authors.lastname: Han
authors.forename: Hee Man
authors.initials: HM
authors.lastname: Kim
authors.forename: Jae Hee
authors.initials: JH
authors.lastname: Cho
authors.forename: Yu Jin
authors.initials: YJ
authors.lastname: Kim
mesh_terms: D000236:Adenoma / Q000150:complications* / Q000175:diagnosis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000150:complications* / Q000175:diagnosis; D003092:Colitis / Q000150:complications / Q000175:diagnosis; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000150:complications* / Q000175:diagnosis; D016145:Endoscopy, Digestive System; D005189:False Positive Reactions; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009780:Occult Blood; D010438:Peptic Ulcer Hemorrhage / Q000175:diagnosis; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000150:complications* / Q000175:diagnosis; D055815:Young Adult
chemical_list: D010975:Platelet Aggregation Inhibitors