Aakriti Soni, MD1, Yuvaraj Singh, MD2, Anuroop Yekula, MD1, Vidit Majmundar, MD1, Mithil Gowda Suresh, MD1, Maya Gogtay, MD3, Lekha Yadukumar, MD4, Syed Asfand Yar Shah, MD1, Sajid Shaik, MD1, Dushyant Singh. Dahiya, MD5, Chidambaram Ramasamy, MD6, Kartikeya Tripathi, MD7, George M. Abraham, MD, MPH1 1Saint Vincent Hospital, Worcester, MA; 2University of Massachusetts, Worcester, MA; 3University of Texas Health, San Antonio, TX; 4Wright Center for Graduate Medical Education, Scranton, PA; 5University of Kansas School of Medicine, Kansas City, KS; 6University of Connecticut, Hartford, CT; 7Quincy Medical Group, Quincy, IL
Introduction: Fecal immunochemical tests (FIT) detect the globin portion of hemoglobin (Hb) by utilizing an antibody assay. Many countries offer FIT as a primary screening modality for colorectal cancer (CRC). There exists a paucity of evidence regarding the effect of medications like nonsteroidal anti-inflammatory drugs (NSAIDs), anticoagulants, and proton pump inhibitors (PPIs) on FIT results. We conducted a systematic review and meta-analysis comparing the use of medications and FIT results in patients undergoing CRC screening.
Methods: We searched PubMed, Medline, CINAHL and the Cochrane database for retrospective or prospective studies, and systematic reviews published on or before September 2022 that reported medication use associated with a positive FIT test. We collected data for the prevalence of a false positive FIT test (FP-FIT), patient characteristics, co-morbidities, and medication use. Review Manager was used in the meta-analysis of the extracted data. Forest plots were used in the presentation of the outcomes of the study with p-value ≤ 0.05, indicating a significant difference.
Results: 6462 studies underwent title and abstract screening, and 130 studies underwent full-text review, out of which 13 studies (n=3097) had a normal colonoscopy and met our inclusion criteria. They were published between 2004 to 2021 and consisted of prospective and retrospective studies. Studies were conducted in an out-patient setting. Our meta-analysis comparing anticoagulants to NSAIDs/Aspirin use involved four studies (N=595) with 153 (25.7%) on anticoagulants and 442 on NSAIDs/Aspirin having FP-FIT tests, with an odds ratio (OR)=1.41 [0.84-2.38,p=0.20]. Secondly, three studies (N=889) compared subjects on PPI (N=400 i.e. 44.99%) vs. subjects on NSAIDs/antiplatelet (N=489) with FP FIT, which showed an OR = 1.18 [0.87-1.59, p=0.29]. Lastly, two studies (N=346) compared 310 (89.59%) subjects on PPI with 36 subjects on anticoagulation with FP FIT, with OR = 1.06 [0.53-2.12, p=0.87].
Discussion: When compared to each other, commonly used medications like PPI, NSAIDs, aspirin, other antiplatelet agents and anticoagulants had no difference in predicting falsely positive FIT tests. Further studies are needed to investigate if combining the above medications or, their varied dosages, have an effect on FIT. With FIT testing being a widely adopted tool for colon cancer screening, it is vital we have guidelines regarding the use of medications and FIT.
Figure: Figure 1 showing a Forest plot on PPI vs anticoagulants and Figure 2 depicting a funnel plot
Disclosures:
Aakriti Soni indicated no relevant financial relationships.
Yuvaraj Singh indicated no relevant financial relationships.
Anuroop Yekula indicated no relevant financial relationships.
Vidit Majmundar indicated no relevant financial relationships.
Mithil Gowda Suresh indicated no relevant financial relationships.
Maya Gogtay indicated no relevant financial relationships.
Lekha Yadukumar indicated no relevant financial relationships.
Syed Asfand Yar Shah indicated no relevant financial relationships.
Sajid Shaik indicated no relevant financial relationships.
Dushyant Dahiya indicated no relevant financial relationships.
Chidambaram Ramasamy indicated no relevant financial relationships.
Kartikeya Tripathi indicated no relevant financial relationships.
George M. Abraham indicated no relevant financial relationships.
Aakriti Soni, MD1, Yuvaraj Singh, MD2, Anuroop Yekula, MD1, Vidit Majmundar, MD1, Mithil Gowda Suresh, MD1, Maya Gogtay, MD3, Lekha Yadukumar, MD4, Syed Asfand Yar Shah, MD1, Sajid Shaik, MD1, Dushyant Singh. Dahiya, MD5, Chidambaram Ramasamy, MD6, Kartikeya Tripathi, MD7, George M. Abraham, MD, MPH1. P0183 - A Comparison of Medications Associated With False Positive FIT: A Systematic Review and Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
