{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T09:08:34Z","timestamp":1789031314273,"version":"build-2803163510"},"reference-count":24,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: FOBT is widely used for colorectal cancer screening in asymptomatic populations but is frequently applied in hospitalized patients with anemia or suspected gastrointestinal bleeding despite limited supporting evidence. Objectives: To evaluate the clinical utility of fecal occult blood testing (FOBT) in hospitalized patients, focusing on its indications and its association with endoscopic findings while accounting for differential endoscopic verification. Methods: We conducted a retrospective study of 160 hospitalized adults who underwent FOBT at a medium-complexity referral center. Demographic, clinical, and endoscopic data were extracted from electronic medical records. Group comparisons used Wilcoxon rank-sum, chi-square, or Fisher\u2019s exact tests; multivariable logistic regression, verification-bias-corrected diagnostic accuracy (Begg\u2013Greenes method), and multiple imputation assessed the association between FOBT and endoscopic findings. Results: FOBT was positive in 61.3% of patients. Anemia was the main indication (51%), followed by melena (26%) and hematochezia (6.9%). FOBT positivity was significantly associated with anemia at admission (82% vs. 68%, p = 0.044) and hematochezia (10% vs. 0%, p = 0.007). Endoscopic verification differed markedly by the FOBT result (71% vs. 29%), and no significant association between FOBT positivity and abnormal endoscopic findings persisted after multivariable adjustment or bias correction, for either EGD (OR 2.01, 95%CI 0.66\u20136.10) or colonoscopy (OR 4.58, 95%CI 0.39\u201354.3). Conclusions: FOBT shows no robust diagnostic association with endoscopic pathology, upper or lower, once differential verification is accounted for. Its main actionable finding was frequent guideline-discordant use in patients with overt bleeding, identifying institutional stewardship as the primary target for improving diagnostic efficiency in inpatient care.<\/jats:p>","DOI":"10.3390\/diagnostics16182921","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T08:07:41Z","timestamp":1789027661000},"page":"2921","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Indications and Endoscopic Correlates of Fecal Occult Blood Testing in Hospitalized Patients"],"prefix":"10.3390","volume":"16","author":[{"given":"Ferney Samuel","family":"Contento-Anaya","sequence":"first","affiliation":[{"name":"Programa de Especializaci\u00f3n en Medicina Interna, Universidad del Sin\u00fa, Cartagena 130001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Fabio Andres","family":"Contento-Anaya","sequence":"additional","affiliation":[{"name":"Departamento de Gastroenterolog\u00eda, Cl\u00ednica Santa Mar\u00eda, Sincelejo 700001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Mario","family":"Montoya Jaramillo","sequence":"additional","affiliation":[{"name":"Programa de Especializaci\u00f3n en Medicina Interna, Universidad del Sin\u00fa, Cartagena 130001, Colombia"},{"name":"Departamento de Gastroenterolog\u00eda, Cl\u00ednica Santa Mar\u00eda, Sincelejo 700001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Fernando","family":"Barros Gomez","sequence":"additional","affiliation":[{"name":"Departamento de Gastroenterolog\u00eda, Cl\u00ednica Santa Mar\u00eda, Sincelejo 700001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5455-9631","authenticated-orcid":false,"given":"Daniel","family":"Botero Alonso","sequence":"additional","affiliation":[{"name":"Centro de Investigaciones en Ciencias de la Vida, Facultad de Ciencias de la Salud, Universidad Sim\u00f3n Bol\u00edvar, Barranquilla 080001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"validation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Mileidys","family":"Correa Monterrosa","sequence":"additional","affiliation":[{"name":"Programa de Especializaci\u00f3n en Medicina Interna, Universidad del Sin\u00fa, Cartagena 130001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Alex","family":"Dominguez-Vargas","sequence":"additional","affiliation":[{"name":"Data Analysis and Mining Department, Data & Project Consulting Service, Barranquilla 080001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7434-4568","authenticated-orcid":false,"given":"Henry J.","family":"Gonz\u00e1lez-Torres","sequence":"additional","affiliation":[{"name":"Centro de Investigaciones en Ciencias de la Vida, Facultad de Ciencias de la Salud, Universidad Sim\u00f3n Bol\u00edvar, Barranquilla 080001, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"458","DOI":"10.14309\/ajg.0000000000001122","article-title":"ACG Clinical Guidelines: Colorectal Cancer Screening 2021","volume":"116","author":"Shaukat","year":"2021","journal-title":"Am. J. Gastroenterol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"171","DOI":"10.7326\/M13-1484","article-title":"Accuracy of Fecal Immunochemical Tests for Colorectal Cancer: Systematic Review and Meta-Analysis","volume":"160","author":"Lee","year":"2014","journal-title":"Ann. Intern. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e001876","DOI":"10.1136\/bmjgast-2025-001876","article-title":"Faecal Occult Blood Testing: A Review of Its Use and Common Misutilisation","volume":"12","author":"Shuja","year":"2025","journal-title":"BMJ Open Gastroenterol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s11894-013-0333-5","article-title":"Lower GI Bleeding: Epidemiology and Management","volume":"15","author":"Ghassemi","year":"2013","journal-title":"Curr. Gastroenterol. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1097\/MEG.0b013e328313bbd3","article-title":"Inappropriate Use of the Faecal Occult Blood Test in a University Hospital in the Netherlands","volume":"24","author":"Stroobants","year":"2012","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1155\/2014\/697103","article-title":"Use of Fecal Occult Blood Testing in Hospitalized Patients: Results of an Audit","volume":"28","author":"Ip","year":"2014","journal-title":"Can. J. Gastroenterol. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"662","DOI":"10.14309\/ajg.0000000000000495","article-title":"Use of Fecal Occult Blood Testing as a Diagnostic Tool for Clinical Indications: A Systematic Review and Meta-Analysis","volume":"115","author":"Lee","year":"2020","journal-title":"Am. J. Gastroenterol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1038\/nrgastro.2010.42","article-title":"Occult and Obscure Gastrointestinal Bleeding: Causes and Clinical Management","volume":"7","author":"Rockey","year":"2010","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"567","DOI":"10.12788\/jhm.2773","article-title":"Fecal Occult Blood Testing in Hospitalized Patients with Upper Gastrointestinal Bleeding","volume":"12","author":"Mathews","year":"2017","journal-title":"J. Hosp. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2030","DOI":"10.1136\/gutjnl-2021-325210","article-title":"British Society of Gastroenterology Guidelines for the Management of Iron Deficiency Anaemia in Adults","volume":"70","author":"Snook","year":"2021","journal-title":"Gut"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1007\/s10350-007-9123-1","article-title":"Classic \u201cOutlet\u201d Rectal Bleeding Does Not Require Full Colonoscopy to Exclude Significant Pathology","volume":"51","author":"Marderstein","year":"2008","journal-title":"Dis. Colon Rectum"},{"key":"ref_12","unstructured":"Antunes, C., Tian, C., and Copelin, E.L. (2024). Upper Gastrointestinal Bleeding. StatPearls, StatPearls Publishing."},{"key":"ref_13","first-page":"5","article-title":"Diagnostic Stewardship in LMICs: The Way Forward","volume":"2","author":"Gupta","year":"2024","journal-title":"J. Antimicrob. Steward. Pract. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1007\/s11606-010-1375-0","article-title":"Effect of Verification Bias on the Sensitivity of Fecal Occult Blood Testing: A Meta-Analysis","volume":"25","author":"Rosman","year":"2010","journal-title":"J. Gen. Intern. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"d4770","DOI":"10.1136\/bmj.d4770","article-title":"Verification Problems in Diagnostic Accuracy Studies: Consequences and Solutions","volume":"343","author":"Bossuyt","year":"2011","journal-title":"BMJ"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1177\/0272989X9101100203","article-title":"The Efficacy of Diagnostic Imaging","volume":"11","author":"Fryback","year":"1991","journal-title":"Med. Decis. Mak."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"207","DOI":"10.2307\/2530820","article-title":"Assessment of Diagnostic Tests When Disease Verification Is Subject to Selection Bias","volume":"39","author":"Begg","year":"1983","journal-title":"Biometrics"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1080\/01621459.1996.10476908","article-title":"Multiple Imputation after 18+ Years","volume":"91","author":"Rubin","year":"1996","journal-title":"J. Am. Stat. Assoc."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Day, E., Eldred-Evans, D., Prevost, A.T., Ahmed, H.U., and Fiorentino, F. (2022). Adjusting for Verification Bias in Diagnostic Accuracy Measures When Comparing Multiple Screening Tests\u2014An Application to the IP1-PROSTAGRAM Study. BMC Med. Res. Methodol., 22.","DOI":"10.1186\/s12874-021-01481-w"},{"key":"ref_20","first-page":"430","article-title":"Evaluation of Occult Gastrointestinal Bleeding","volume":"87","year":"2013","journal-title":"Am. Fam. Physician"},{"key":"ref_21","first-page":"98","article-title":"Iron Deficiency Anemia: Evaluation and Management","volume":"87","author":"Short","year":"2013","journal-title":"Am. Fam. Physician"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"91","DOI":"10.2188\/jea.JE20210057","article-title":"Effectiveness of Screening Using Fecal Occult Blood Testing and Colonoscopy on the Risk of Colorectal Cancer: The Japan Public Health Center-Based Prospective Study","volume":"33","author":"Tanaka","year":"2023","journal-title":"J. Epidemiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1001\/jama.2021.6238","article-title":"Screening for Colorectal Cancer","volume":"325","author":"Davidson","year":"2021","journal-title":"JAMA"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2431","DOI":"10.1158\/1055-9965.EPI-20-0234","article-title":"Biomarkers for Early Detection of Colorectal Cancer: The Early Detection Research Network, a Framework for Clinical Translation","volume":"29","author":"Bresalier","year":"2020","journal-title":"Cancer Epidemiol. Biomark. Prev."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/2921\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T08:26:30Z","timestamp":1789028790000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/18\/2921"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,10]]},"references-count":24,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["diagnostics16182921"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16182921","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,10]]}}}