FIT in shape for new role in ulcerative colitis monitoring

Fecal immunochemical tests (FITs) could allow noninvasive assessment of patients with ulcerative colitis (UC), say the authors of a Japanese study.

They found that FIT, which is routinely used in colon cancer screening, may indicate mucosal status, with a negative FIT result suggesting mucosal healing.

"By making use of FIT, treatment strategy for UC patients could be determined in many situations without performing colonoscopy," say Sakiko Hiraoka (Okayama University, Japan) and colleagues.

They enrolled 152 UC patients between 2006 and 2011 who underwent 310 colonoscopies in total. Of these, 57% were performed in patients with active disease.

The authors, reporting in the American Journal of Gastroenterology, found that as Mayo endoscopic score increased (indicating less mucosal healing), the proportion of patients with hemoglobin concentrations lower than 100 ng/mL decreased. Overall, 92% of patients with a Mayo score of 0 had a hemoglobin level below this threshold compared with only 12% of patients with a Mayo score of 3.

The authors also showed that a negative FIT result could be used to predict mucosal healing with a sufficient level of specificity and sensitivity to indicate which patients have been adequately treated. For example, fecal hemoglobin concentrations of less than 60 ng/mL predicted a Mayo endoscopic score of 0 with 94% sensitivity and 74% specificity.

Additionally, the authors found that FIT scores correlate with overall disease activity, as measured by total Mayo score.

Mucosal healing has emerged as an important goal in UC treatment, in addition to achieving clinical remission. However, the need for colonoscopy has several drawbacks for patients.

"In addition to the colonoscopy procedure itself, bowel preparations, possible worsening of disease after colonoscopy, and high cost are all matters of concern to patients," explain Hiraoka and colleagues.

They conclude that FIT could provide a welcome and practical alternative: "Because repeated evaluations of mucosal healing are required over the duration of UC, the noninvasive, low-cost, and rapid FIT is a suitable method that can be applied at each patient's hospital or clinic visit."

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