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. 2023 Feb 13:14:1128736.
doi: 10.3389/fimmu.2023.1128736. eCollection 2023.

Positive faecal immunochemical test predicts the onset of inflammatory bowel disease: A nationwide, propensity score-matched study

Eunyoung Lee  1   2 , Gil Ho Lee  3 , Bumhee Park  1   2 , Sung Soo Ahn  4 , Choong-Kyun Noh  3
Affiliations

Positive faecal immunochemical test predicts the onset of inflammatory bowel disease: A nationwide, propensity score-matched study

Eunyoung Lee et al. Front Immunol. .

Abstract

Background & aims: The faecal immunochemical test (FIT), a non-invasive test for screening colorectal cancer (CRC), is being increasingly understood to reflect heightened inflammation. We aimed to investigate the association between abnormal FIT results and onset of inflammatory bowel disease (IBD), a disease characterized with chronic gut mucosal inflammation.

Methods: Participants in the Korean National Cancer Screening Program for CRC between 2009-2013 were analysed and divided into positive and negative FIT result groups. The incidence rates of IBD after screening were calculated after excluding cases of haemorrhoids, CRC, and IBD at baseline. Cox proportional hazard analyses were used to identify independent risk factors for IBD occurrence during follow-up, and 1:2 propensity score matching was performed as a sensitivity analysis.

Results: In total, 229,594 and 815,361 participants were assigned to the positive and negative FIT result groups, respectively. The age- and sex-adjusted incidence rates of IBD in participants with positive and negative test results were 1.72 and 0.50 per 10,000 person-years, respectively. Adjusted Cox analysis revealed that FIT positivity was associated with a significantly higher risk of IBD (hazard ratio 2.93, 95% confidence interval: 2.46, 3.47, P <.001), which was consistent for both disease subtypes of ulcerative colitis and Crohn's disease. The results of Kaplan-Meier analysis in the matched population yielded identical findings.

Conclusions: Abnormal FIT results could be a preceding sign of incident IBD in the general population. Those with positive FIT results and suspected IBD symptoms could benefit from regular screening for early disease detection.

Keywords: faecal immunochemical test; incidence; inflammatory bowel disease; prediction; risk.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
A Flow Diagram of Selecting the FIT (+) and FIT (-) Group. FIT, faecal immunochemical test; CRC, colorectal cancer; IBD, inflammatory bowel disease.
Figure 2
Figure 2
Comparison of IBD incidence rates between the FIT (−) and FIT (+) groups. *Values adjusted for age and sex. IBD, inflammatory bowel disease; FIT, faecal immunochemical test; UC, ulcerative colitis; CD, Crohn’s disease; IR, incidence rate per 10,000 person-years.
Figure 3
Figure 3
Cumulative incidence of IBD, UC, and CD according to FIT results in those with normal haemoglobin. The incidences of (A) IBD, (B) UC, and (C) CD were significantly higher in the positive FIT group than in the negative FIT group. IBD, inflammatory bowel disease; UC, ulcerative colitis; CD, Crohn’s disease; FIT, faecal immunochemical test.
Figure 4
Figure 4
Probability of developing IBD, UC, and CD according to FIT results after PSM. In the matched population, patients with positive FIT results demonstrated a significantly higher risk of (A) IBD, (B) UC, and (C) CD than those with negative FIT results. IBD, inflammatory bowel disease; UC, ulcerative colitis; CD, Crohn’s disease; FIT, faecal immunochemical test; PSM, propensity score matching.
See this image and copyright information in PMC

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