Fecal occult blood testing. Problems, pitfalls, and diagnostic concerns.

The diagnostic approach to the asymptomatic patient who has tested positive for fecal occult blood varies among clinicians. Colonoscopic evaluation is the procedure of choice in initiating the workup of patients 50 years of age and older. In younger patients, examination by sigmoidoscopy and barium enema using air for contrast (double contrast study) may be considered as an alternative to colonoscopy as the initial test. Evaluation of the upper gastrointestinal tract should be considered if a colonic source is not detected. The challenge in diagnostic test selection lies in choosing the most appropriate and cost-effective procedure for detecting disease, especially neoplastic lesions.