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Biathlon
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Not to be confused with duathlon or biathle.
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Biathlon
Biathletes in the shooting area of a competition
Highest governing body
International Biathlon Union
Characteristics
Team members
Single competitors or relay teams
Mixed gender
Yes
Equipment
Skis, poles, rifle
Presence
Olympic
1924 (military patrol)
1960 (officially)
The biathlon is a winter sport that combines cross-country skiing and rifle shooting. It is treated as a race where the contestant with the shortest total time wins. Depending on the competition, missed shots result in extra distance or time added to the contestant's total skiing distance or time.
Contents
[hide]
1 History
2 Governing body
3 Championships
4 Rules and equipment
4.1 Basic concepts
4.2 Skiing details
4.3 Shooting details
5 Competition format
5.1 Individual
5.2 Sprint
5.3 Pursuit
5.4 Mass start
5.5 Relay
5.6 Mixed relay
5.7 Team (obsolete)
6 Broadcasting
7 Biathlon records and statistics
8 See also
9 Notes
10 External links
History[edit]
According to Encyclopædia Britannica, the biathlon "is rooted in the skiing traditions of Scandinavia, where early inhabitants revered the Norse god Ullr as both the ski god and the hunting god". In modern times, the activity that developed into this sport was an exercise for Norwegian people that was an alternative training for the military. Norwegian skiing regiments organized military skiing contests in the 18th century, divided in four classes: shooting at mark while skiing at top speed, downhill race among trees, downhill race on big hills without falling, and a long race on flat ground while carrying rifle and military pack. In modern terminology these military contests included downhill, slalom, biathlon, and cross-country skiing.[1] One of the world's first known ski clubs, the Trysil Rifle and Ski Club, was formed in Norway in 1861 to promote national defense at the local level. 20th century variants include Forsvarsrennet (the military contest) – a 17 km cross-country race with shooting, and the military cross-country race at 30 km including marksmanship. The modern biathlon is a civilian variant of the old military combined exercise.[2] In Norway, the biathlon was until 1984 a branch of Det frivillige Skyttervesen, an organization set up by the government to promote civilian marksmanship in support of national defense. In Norwegian, the biathlon is called skiskyting (literally ski shooting).[3] In Norway there are still separate contests in skifeltskyting, a cross-country race at 12 km with large-caliber rifle shooting at various targets with unknown range.[4]
Called military patrol, the combination of skiing and shooting was contested at the Winter Olympic Games in 1924, and then demonstrated in 1928, 1936, and 1948, but did not regain Olympic recognition then because the small number of competing countries disagreed on the rules. During the mid-1950s, however, the biathlon was introduced into the Soviet and Swedish winter sport circuits and was widely enjoyed by the public. This newfound popularity aided the effort of having the biathlon gain entry into the Winter Olympics.
The first Biathlon World Championship was held in 1958 in Austria, and in 1960 the sport was finally included in the Olympic Games.[3] At Albertville in 1992, women were first allowed in the Olympic biathlon.
The competitions from 1958 to 1965 used high-power centerfire cartridges, such as the .30-06 Springfield and the 7.62×51mm NATO, before the .22 Long Rifle rimfire cartridge was standardized in 1978. The ammunition was carried in a belt worn around the competitor's waist. The sole event was the men's 20 kilometres (12 mi) individual, encompassing four separate ranges and firing distances of 100 metres (330 ft), 150 metres (490 ft), 200 metres (660 ft), and 250 metres (820 ft). The target distance was reduced to 150 metres (490 ft) with the addition of the relay in 1966. The shooting range was further reduced to 50 metres (160 ft) in 1978 with the mechanical targets making their debut at the 1980 Winter Olympics in Lake Placid.[5]
Governing body[edit]
In 1948, the Union Internationale de Pentathlon Moderne et Biathlon (UIPMB) was founded, to standardise the rules for the biathlon and the modern pentathlon. In 1993, the biathlon branch of the UIPMB created the International Biathlon Union (IBU), which officially separated from the UIPMB in 1998.
Presidents of the UIPMB/IBU:
1947–1949: Tom Wiborn (Sweden)
1949–1960: Gustaf Dyrssen (Sweden)
1960–1988: Sven Thofelt, (Sweden)
1988–1992: Igor Novikov (USSR/Russia)
Since 1992: Anders Besseberg (Norway)
Championships[edit]
The following articles list major international biathlon events and medalists. Contrary to the Olympics and World Championships (BWCH), the World Cup (BWC) is an entire winter season of (mostly) weekly races, where the medalists are those with the highest sums of World Cup points at the end of the season.
Biathlon at the Winter Olympics
Biathlon World Championships
Biathlon World Cup
Biathlon Junior World Championships
Rules and equipment[edit]
Prone position: Sylvie Becaert, Antholz 2010.
Standing position: Raphaël Poirée (left) and Ole Einar Bjørndalen, Antholz 2006.
The complete rules of the biathlon are given in the official IBU rule books.[6]
Basic concepts[edit]
A biathlon competition consists of a race in which contestants ski through a cross-country trail system whose total distance is divided into either two or four shooting rounds, half in prone position, the other half standing. Depending on the shooting performance, extra distance or time is added to the contestant's total skiing distance/time. The contestant with the shortest total time wins.
For each shooting round, the biathlete must hit five targets or receive a penalty for each missed target, which varies according to the competition rules, as follows:[6]
Skiing around a 150-metre (490 ft) penalty loop—typically taking 20–30 seconds for elite biathletes to complete, depending on weather and snow conditions.
Adding one minute to the skier's total time.
Use of an extra cartridge (placed at the shooting range) to hit the target; only three such extras are available for each round, and a penalty loop must be done for each target left standing.
In order to keep track of the contestants' progress and relative standing throughout a race, split times (intermediate times) are taken at several points along the skiing track and upon finishing each shooting round. The large display screens commonly set up at biathlon arenas, as well as the information graphics shown as part of the TV picture, will typically list the split time of the fastest contestant at each intermediate point and the times and time differences to the closest runners-up.
Skiing details[edit]
In the Olympics, all cross-country skiing techniques are permitted in the biathlon, allows the use of skate skiing,[7] which is overwhelmingly the choice of competitors. The minimum ski length is the height of the skier minus 4 centimetres (1.6 in). The rifle has to be carried by the skier during the race at all times.
Shooting details[edit]
The biathlete carries a small-bore rifle, which weighs at least 3.5 kilograms (7.7 lb), excluding ammunition and magazines. The rifles use .22 LR ammunition and are bolt action or Fortner (straight-pull bolt) action. The rifle must weight more than 3.5 kilograms. Each rifle holds 4 magazines with 5 rounds each. Addtional rounds can be kept on the stock of the rifle for a relay race.
The target range shooting distance is 50 metres (160 ft). There are five circular targets to be hit in each shooting round. When shooting in the prone position, the target diameter is 45 millimetres (1.8 in); when shooting in the standing position, the target diameter is 115 millimetres (4.5 in). On all modern biathlon ranges, the targets are self-indicating, in that they flip from black to white when hit, giving the biathlete, as well as the spectators, instant visual feedback for each shot fired.
Competition format[edit]
Individual[edit]
The 20 kilometres (12 mi) individual race (15 kilometres (9.3 mi) for women) is the oldest biathlon event; the distance is skied over five laps. The biathlete shoots four times at any shooting lane,[8] in the order of prone, standing, prone, standing, totaling 20 targets. For each missed target a fixed penalty time, usually one minute, is added to the skiing time of the biathlete. Competitors' starts are staggered, normally by 30 seconds.
Sprint[edit]
The sprint is 10 kilometres (6.2 mi) for men and 7.5 kilometres (4.7 mi) for women; the distance is skied over three laps. The biathlete shoots twice at any shooting lane, once prone and once standing, for a total of 10 shots. For each miss, a penalty loop of 150 metres (490 ft) must be skied before the race can be continued. As in the individual competition, the biathletes start in intervals.
Pursuit[edit]
Olympic gold medalists Olga Zaitseva and Andrea Henkel at the World Cup pursuit race in Oberhof, 2013.
Main article: Pursuit racing
In a pursuit, biathletes' starts are separated by their time differences from a previous race,[9] most commonly a sprint. The contestant crossing the finish line first is the winner. The distance is 12.5 kilometres (7.8 mi) for men and 10 kilometres (6.2 mi) for women, skied over five laps; there are four shooting bouts (two prone, two standing, in that order), and each miss means a penalty loop of 150 metres (490 ft). To prevent awkward or dangerous crowding of the skiing loops, and overcapacity at the shooting range, World Cup Pursuits are held with only the 60 top ranking biathletes after the preceding race. The biathletes shoot on a first-come, first-served basis at the lane corresponding to the position they arrived for all shooting bouts.
Mass start[edit]
In the mass start, all biathletes start at the same time and the first across the finish line wins. In this 15 kilometres (9.3 mi) for men or 12.5 kilometres (7.8 mi) for women competition, the distance is skied over five laps; there are four bouts of shooting (two prone, two standing, in that order) with the first shooting bout being at the lane corresponding to the competitor's bib number (Bib #10 shoots at lane #10 regardless of position in race), with the rest of the shooting bouts being on a first-come, first-served basis (If a competitor arrives at the lane in fifth place, they shoot at lane 5). As in sprint and pursuit, competitors must ski one 150 metres (490 ft) penalty loop for each miss. Here again, to avoid unwanted congestion, World Cup Mass starts are held with only the 30 top ranking athletes on the start line (half that of the Pursuit as here all contestants start simultaneously).
Relay[edit]
The relay teams consist of four biathletes, who each ski 7.5 kilometres (4.7 mi) (men) or 6 kilometres (3.7 mi) (women), each leg skied over three laps, with two shooting rounds; one prone, one standing. For every round of five targets there are eight bullets available, though the last three can only be single-loaded manually one at a time from spare round holders or bullets deposited by the competitor into trays or onto the mat at the firing line. If after eight bullets there are still misses, one 150 m (490 ft) penalty loop must be taken for each missed target remaining. The first-leg participants start all at the same time, and as in cross-country skiing relays, every athlete of a team must touch the team's next-leg participant to perform a valid changeover. On the first shooting stage of the first leg, the participant must shoot in the lane corresponding to their bib number (Bib #10 shoots at lane #10 regardless of position in race), then for the remainder of the relay, the relay team shoots on a first-come, first-served basis (arrive at the range in fifth place, shoot at lane 5).
Mixed relay[edit]
The most recent addition to the number of biathlon competition variants, the mixed relay is similar to the ordinary relay but the teams are composed of two women and two men. Legs 1 and 2 are done by the women, legs 3 and 4 by the men. The women's legs are 6 kilometres (3.7 mi) and men's legs are 7.5 kilometres (4.7 mi) as in ordinary relay competitions.
In 2014, single mixed relay was introduced by the IBU. Each team has a man and a woman, and each runs two 3.0 kilometres (1.9 mi) legs, except the last leg where the man completes 4.5 kilometres (2.8 mi) for a total 13.5 kilometres (8.4 mi).
This event was first held at the Biathlon World Championships 2005 in Khanty-Mansiysk, and it was added to the 2014 Winter Olympics.
Team (obsolete)[edit]
A team consists of four biathletes, but unlike the relay competition, all team members start at the same time. Two athletes must shoot in the prone shooting round, the other two in the standing round. In case of a miss, the two non-shooting biathletes must ski a penalty loop of 150 m (490 ft). The skiers must enter the shooting area together, and must also finish within 15 seconds of each other; otherwise a time penalty of one minute is added to the total time. Since 2004, this race format has been obsolete at the World Cup level.
Broadcasting[edit]
Biathlon events are broadcast most regularly where the sport enjoys its greatest popularity, namely Germany (ARD, ZDF), Austria (ORF), Norway (NRK), France (L'Équipe 21), Finland (YLE), Estonia (ETV), Latvia (LTV), Lithuania (LRT), Croatia (HRT), Poland (Polsat), Sweden (SVT), Russia (Russia-2, Channel One), Belarus (TVR), Slovenia (RTV), Bosnia and Herzegovina (BHRT), Bulgaria (BNT), and South Korea (KBS); it is broadcast on European-wide Eurosport, which also broadcasts to the Asia-Pacific region. World Cup races are streamed (without commentary) via the IBU website.[10]
The broadcast distribution being one indicator, the constellation of a sport's main sponsors usually gives a similar, and correlated, indication of popularity: for biathlon, these are the Germany-based companies E.ON Ruhrgas (energy), Krombacher (beer), and Viessmann (boilers and other heating systems).
United States biathlete Jeremy Teela at the 2002 Winter Olympics.
Biathlon records and statistics[edit]
The IBU maintains biathlon records, rules, news, videos, and statistics for many years back, all of which are available at its web site.[11]
See also[edit]
Biathlon World Cup
Biathlon World Championships
List of Olympic medalists in biathlon
Paralympic biathlon
Biathlon's two sports disciplines:
Cross-country skiing (sport)
Rifle shooting sports
Other multi-discipline sports (otherwise unrelated to biathlon):
Duathlon
Nordic Combined
Triathlon
Pentathlon
Modern pentathlon
Heptathlon
Decathlon
Chess boxing
Omnium (track cycling)
Notes[edit]
Jump up ^ Bergsland, Einar (1946): På ski. Oslo: Aschehoug.
Jump up ^ Bø, Olav: Skiing throughout history, translated by W. Edson Richmond. Oslo: Samlaget, 1993.
^ Jump up to: a b Kunnskapsforlagets idrettsleksikon (Encyclopedia of Sports), Oslo: Kunnskapsforlaget, 1990
Jump up ^ https://snl.no/skifeltskyting
Jump up ^ "Biathlon: a sport on the cutting edge". olympic.org. 23 February 2015. Retrieved 25 January 2018.
^ Jump up to: a b IBU Congress (2014), IBU Event and Competition Rules (PDF), archived from the original (PDF) on 2016-03-03
Jump up ^ "Competition format and rules: Biathlon, as of January 2018" (PDF). 2018. Retrieved 2018-03-30.
Jump up ^ Even in English-speaking countries such as Canada and the United States each country may use different terms for the same thing in biathlon. For example: Stage (USA) vs. Bout (Canada), Shooting Point (USA) vs. Shooting Lane (Canada)
Jump up ^ To be precise; the pursuit competition start intervals are determined by common rounding to the nearest whole second of the biathletes' time differences from the previous race – the amount of time each biathlete lagged after the winner to the finish line.
Jump up ^ Startseite - www.biathlonworld.com
Jump up ^ IBU (2016). "The Biathlon Family". biathlonworld.com. International Biathlon Union. Retrieved 2017-02-11.
External links[edit]
Wikimedia Commons has media related to Biathlon.
Biathlonworld.Com – A cooperation between IBU and EBU; with race results/statistics, TV schedules, live competition results, and so on.
Belarusian Biathlon Union (in Russian)
Russian Biathlon Union (in Russian)
Russian Biathlon Union (in English)
Biathlon Canada
U.S. Biathlon Association
U.S. Archery Biathlon
History of Biathlon
Veltins Biathlon World Team Challenge
Biathlon on OLN TV
Biathlon on DVD
Biathlon Russia
Biathlon Ukraine (in Ukrainian)
Biathlon Ukraine (in English)
BiathlonFrance.com
Biathlon history (in Russian)
Popular Norwegian site (in Norwegian)
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text:
Fecal occult blood
From Wikipedia, the free encyclopedia
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Fecal occult blood
Cards and bottle used for the Hemoccult test, a type of stool guaiac test
Classification and external resources
ICD-10
R19.5
ICD-9-CM
792.1
DiseasesDB
30751
MedlinePlus
007008
MeSH
D009780
[edit on Wikidata]
Fecal occult blood (FOB) refers to blood in the feces that is not visibly apparent (unlike other types of blood in stool such as melena or hematochezia). A fecal occult blood test (FOBT) checks for hidden (occult) blood in the stool (feces).[1]
Other tests look for globin, DNA, or other blood factors including transferrin, while conventional stool guaiac tests look for heme.
Contents
[hide]
1 Medical uses
1.1 Source of bleeding
1.2 Stool color
1.3 Colorectal cancer screening
1.4 Iron deficiency anemia
1.5 Gastrointestinal disease and medications
1.6 Testing secretions for occult blood
1.7 Regulatory impact
2 Marathon runners
3 Nomenclature
4 Methodology
5 Test performance
5.1 Reference standards
5.2 Gastrointestinal blood loss
5.3 Clinical sensitivity and specificity
6 References
7 External links
Medical uses[edit]
Fecal occult blood testing (FOBT), as its name implies, aims to detect subtle blood loss in the gastrointestinal tract, anywhere from the mouth to the colon. Positive tests ("positive stool") may result from either upper gastrointestinal bleeding or lower gastrointestinal bleeding and warrant further investigation for peptic ulcers or a malignancy (such as colorectal cancer or gastric cancer). The test does not directly detect colon cancer but is often used in clinical screening for that disease, but it can also be used to look for active occult blood loss in anemia[2] or when there are gastrointestinal symptoms.[3]
The stool guaiac test for hidden (occult) blood in the stool can be done at home or in the doctor's office, or can be performed on samples submitted to a clinical laboratory. Testing kits are available at pharmacies in some countries without a prescription, or a health professional may order a testing kit for use at home. If a home fecal occult blood test detects blood in the stool it is recommended to see a health professional to arrange further testing.[4]
Source of bleeding[edit]
Gastrointestinal bleeding has many potential sources, and positive results usually result in further testing for the bleeding site, usually looking for lower gastrointestinal bleeding before upper gastrointestinal bleeding causes unless there are other clinical clues.[5] Colonoscopy is usually preferred to computerized tomographic colonography.[6]
An estimated 1–5% of large tested populations have a positive fecal occult blood test.[citation needed] Of those, about 2–10% have cancer, while 20–30% have adenomas.
A positive test can result from upper gastrointestinal bleeding or lower gastrointestinal bleeding. The common causes are:
2–10%: cancer (colorectal cancer, gastric cancer)
20–30% adenoma or polyps
Diverticular disease[7]
Hemorrhoids[7]
Inflammatory bowel disease[7]
Angiodysplasia of the colon
Sickle cell anemia
In the event of a positive fecal occult blood test, the next step in the workup is a form of visualization of the gastrointestinal tract by one of several means:
Sigmoidoscopy, an examination of the rectum and lower colon with a lighted instrument to look for abnormalities, such as polyps.
Colonoscopy, a more thorough examination of the rectum and entire colon.
Virtual colonoscopy
Upper gastrointestinal endoscopy. It is sometimes performed with chromoendoscopy, a method that assists the endoscopist by enhancing the visual difference between cancerous and normal tissue, either by marking the abnormally increased DNA content (toluidine blue) or failing to stain the tumor, possibly due to decreased surface glycogen on tumor cells(Lugol).[8][9] Infrared fluorescent endoscopy[citation needed] and ultrasonic endoscopy[citation needed] can interrogate vascular abnormalities such as esophageal varices.
Double contrast barium enema: a series of x-rays of the colon and rectum.
Stool color[edit]
Although red or black stools can be an indication of bleeding, a dark or black color can also be due to black licorice, blueberries, iron supplements, lead or Pepto-bismol, and a reddish color can result from artificial or natural colorings as found in red sweets (gelatin, popsicles, Kool-Aid), or large quantities of beets.
Colorectal cancer screening[edit]
Screening methods for colon cancer depend on detecting either precancerous changes such as certain kinds of polyps or on finding early and thus more treatable cancer. The extent to which screening procedures reduce the incidence of gastrointestinal cancer or mortality depends on the rate of precancerous and cancerous disease in that population. gFOBT (guaiac fecal occult blood test) and flexible sigmoidoscopy screening have each shown benefit in randomized clinical trials.[citation needed] Evidence for other colon cancer screening tools such as iFOBT (immunochemical fecal occult blood test) or colonoscopy is substantial and guidelines have been issued by several advisory groups but does not include randomized studies.
In 2009 the American College of Gastroenterology (ACG) suggest that colon cancer screening modalities that are also directly preventive by removing precursor lesions should be given precedence, and prefer a colonoscopy every 10 years in average-risk individuals, beginning at age 50.[10] The ACG suggests that cancer detection tests such as any type of FOB are an alternative that is less preferred, and if a colonoscopy is declined, the FIT (fecal immunochemical test, or iFOBT) should be offered instead. Two other recent guidelines, from the US Multisociety Task Force (MSTF) and the US Preventive Services Task Force (USPSTF), while permitting immediate colonoscopy as an option, did not categorize it as preferred.[11][12] The ACG and MSTF also included CT colonography every five years, and fecal DNA testing as considerations. All three recommendation panels recommended replacing any older low-sensitivity, guaiac-based fecal occult blood testing (gFOBT) with either newer high-sensitivity guaiac-based fecal occult blood testing (hs gFOBT) or fecal immunochemical testing (FIT). MSTF looked at six studies that compared high sensitivity gFOBT (Hemoccult SENSA) to FIT, and concluded that there was no clear difference in overall performance between these methods.
The American College of Gastroenterology has recommended the abandoning of gFOBT testing as a colorectal cancer screening tool, in favor of the fecal immunochemical test.[13] Though the FIT test is preferred, even the guaiac FOB testing of average risk populations may have been sufficient to reduce the mortality associated with colon cancer by about 25%.[14] With this lower efficacy, it was not always cost effective to screen a large population with gFOBT.[15][16][17][18]
If colon cancer is suspected in an individual (such as in someone with an unexplained anemia) fecal occult blood tests may not be clinically helpful. If a doctor suspects colon cancer, more rigorous investigation is necessary, whether or not the test is positive.
In 2006, the Australian Government introduced the National Bowel Cancer Program which has been updated several times since; targeted screening will be done of all Australians aged over 50 to 74 by 2017–2018. Cancer Council Australia recommended that FOBT should be done every two years. Gradually government fund disbursement meant that some people are not yet eligible for the national program and should pay for a FOBT by themselves.[19]
The Canadian Cancer Society recommends that men and women age 50 and over have a FOBT at least every 2 years.[20]
In colon cancer screening, using only one sample of feces collected by a doctor performing a digital rectal examination is discouraged.[21]
The use of the M2-PK Test is encouraged over gFOBT for routine screening as it may pick up tumors that are both bleeding and non bleeding.[22] It is able to pick up 80 percent of colorectal cancer and 44 percent for adenoma > 1 centimeter, while gFOBT picks up 13 to 50 percent of colorectal cancers.[22]
Iron deficiency anemia[edit]
An extensive literature has examined the clinical value of FOBT in iron deficiency anemia.
Gastrointestinal disease and medications[edit]
Conditions such as ulcerative colitis or certain types of relapsing infectious diarrhea can vary in severity over time, and FOBT may assist in assessing the severity of the disease. Medications associated with gastrointestinal bleeding such as Bortezomib are sometimes monitored by FOBT.
Testing secretions for occult blood[edit]
The use of tests for fecal occult blood in disorders of the mouth, nasal passages, esophagus, lungs and stomach, while analogous to fecal testing, is often discouraged, due to technical considerations including poorly characterized test performance characteristics such as sensitivity, specificity, and analytical interference. However, chemical confirmation that coloration is due to blood rather than coffee, beets, medications, or food additives can be of significant clinical assistance.
Regulatory impact[edit]
Safety regulations from US accreditor the Joint Commission may have unintentionally decreased digital rectal examination and FOBT in hospital settings such as Emergency Departments.[23][24]
Marathon runners[edit]
Gastrointestinal (GI) complaints and low intensity GI bleeding frequently occur in marathon runners.[25] Strenuous exercise, particularly in elite athlete runners and less frequently in other exercise activities, can cause acute incapacitating gastrointestinal symptoms including heartburn, nausea, vomiting, abdominal pain, diarrhea and gastrointestinal bleeding.[26] Approximately one third of endurance runners experience transient but exercise limiting symptoms, and repetitive gastrointestinal bleeding occasionally causes iron deficiency and anaemia.[27] Runners can sometimes experience significant symptoms including hematemesis.[28] Exercise is associated with extensive changes in gastrointestinal (GI) tract physiology, including diversion of blood flow from the GI tract to muscle and lungs, decreased GI absorption and small intestinal motility, increased colonic transit, neuroimmunoendocrine changes in hormones and peptides such as vasoactive intestinal peptide, secretin and peptide-histidine-methionine.[29] Substantial changes occur in stress hormones including cortisol, in circulating concentrations and metabolic behavior of various leucocytes, and in immunoglobulin levels and major histocompatibility complex expression.[30] Symptoms can be exacerbated by dehydration or by pre-exercise ingestion of certain foods and hypertonic liquids, and lessened by adequate training.[29]
Ingestion of 800 mg of cimetidine 2 hr before running a marathon did not significantly affect the frequency of gastrointestinal symptoms or occult gastrointestinal bleeding.[31] Conversely, 800 mg of cimetidine 1 hr before the start and again at 50 miles of a 100-mile running race substantially decreased GI symptoms and postrace guaiac test positivity but did not affect race performance.[32]
Nomenclature[edit]
In 2007 the nomenclature of overt, obscure and occult bleeding was clarified.[citation needed]
Methodology[edit]
There are four methods in clinical use for testing for occult blood in feces. These look at different properties, such as antibodies, heme, globin, or porphyrins in blood, or at DNA from cellular material such as from lesions of the intestinal mucosa.
Fecal immunochemical testing (FIT), and immunochemical fecal occult blood test (iFOBT). FIT products utilize specific antibodies to detect globin. FIT screening is more effective in terms of health outcomes and cost compared with guaiac FOBT.[33] According to the guidelines of the American College of Gastroenterology, "Annual fecal immunochemical testing is the preferred colorectal cancer detection test."[34][35] A FIT test detects globin levels in feces at or above 50 nanograms per mL, the established cutoff by the World Health Organization for Colorectal Cancer Screening.
FIT testing has replaced most gFOBT tests as the colon cancer screening test of choice.[36][37] This methodology can be adapted for automated test reading and to report quantitative results, which are potential factors in design of a widescale screening strategy.[38] The number of fecal samples submitted for FIT may affect the clinical sensitivity and specificity of the methodology.[8] High sensitivity gFOBT tests such as Hemoccult SENSA remains an accepted option;[8] and may retain a role in monitoring gastrointestinal conditions such as ulcerative colitis;[39] however the FIT test is preferred in recent guidelines.[34]
A positive traditional guaiac fecal occult blood test
Stool guaiac test for fecal occult blood (gFOBT): – The stool guaiac test involves smearing some feces onto some absorbent paper that has been treated with a chemical. Hydrogen peroxide is then dropped onto the paper; if trace amounts of blood are present, the paper will change color in one or two seconds. This method works as the heme component in hemoglobin has a peroxidase-like effect, rapidly breaking down hydrogen peroxide. In some settings such as gastric or proximal upper intestinal bleeding the guaiac method may be more sensitive than tests detecting globin because globin is broken down in the upper intestine to a greater extent than is heme.[40] There are various commercially available gFOBT tests which have been categorized as being of low or high sensitivity, and only high sensitivity tests remain an acceptable alternative to FIT testing, which is now the best-practices recommendation in colon cancer screening. Optimal clinical performance of the stool guaiac test depends on preparatory dietary adjustment.[41]
Stool DNA screening tests look for DNA alterations that have been associated with cancer.
Additional methods of looking for occult blood are being explored, including transferrin dipstick[42] and stool cytology.[43]
Test performance[edit]
Reference standards[edit]
The estimates for test performance characteristics are based on comparison with a variety of reference methods including 51-chromium studies,[citation needed] analytical recovery studies in spiked stool samples, analytical recovery after ingestion of autologous blood, rarer studies of carefully quantified blood instilled at bowel surgery[citation needed] as well as other research approaches.[citation needed] Additionally, clinical studies look at variety of additional factors.
Gastrointestinal blood loss[edit]
In healthy people about 0.5 to 1.5 ml of blood escapes blood vessels into the stool each day.[44][45][46] Significant amounts of blood can be lost without producing visible blood in the stool, estimated as 200 ml in the stomach,[47] 100 ml in the duodenum, and lesser amounts in the lower intestine. Tests for occult blood identify lesser blood loss.
Clinical sensitivity and specificity[edit]
Fecal Immunochemical Testing (FIT) can identify as little as 0.3 ml of daily blood in the stool; yet this test threshold doesn't cause undue false positives from normal upper intestinal blood leakage because it does not detect occult blood from the stomach and upper small intestine. Thus the FIT test is much more specific for bleeding from the colon or lower gastrointestinal tract than alternatives.[48] The detection rate of the test decreases if the time from sample collection to laboratory processing is delayed; processing the sample in under five days from collection is recommended.[49]
Stool guaiac test for fecal occult blood (gFOBT) sensitivity varies depending on the site of bleeding. Moderately sensitive gFOBT can pick up a daily blood loss of about 10 ml (about two teaspoonfuls), and higher sensitivity gFOBT can pick up lesser amounts, requires at least 2 ml. to become positive. The sensitivity of a single stool guaiac test to pick up bleeding has been quoted at 10 to 30%, but if a standard three tests are done as recommended the sensitivity rises to 92%.[50] Reduced patient compliance with the collection of three samples hampers the usefulness of this test. Further discussion of sensitivity and specificity issues that relate particularly to the guaiac method is found in the stool guaiac test article.
Fecal porphyrin quantification by HemoQuant can yield a false positive result due to exogenous blood and various porphyrins. HemoQuant is the most sensitive test for upper gastrointestinal bleeding and therefore may be most appropriate fecal occult blood test to use in the evaluation of iron deficiency[51] Advised to stop red meat and aspirin for three days prior to specimen collection[52] False positives can occur with myoglobin, catalase, or protohemes[53] and in certain types of porphyria.[citation needed]
Fecal DNA tests as of 2008 had not been well studied enough to support widespread use.[54]
References[edit]
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^ Jump up to: a b Brouns F, Beckers E (April 1993). "Is the gut an athletic organ? Digestion, absorption and exercise". Sports Med. 15 (4): 242–57. PMID 8460288. doi:10.2165/00007256-199315040-00003.
Jump up ^ Venkatraman JT, Pendergast DR (2002). "Effect of dietary intake on immune function in athletes". Sports Med. 32 (5): 323–37. PMID 11929359. doi:10.2165/00007256-200232050-00004.
Jump up ^ Moses FM, Baska RS, Peura DA, Deuster PA (October 1991). "Effect of cimetidine on marathon-associated gastrointestinal symptoms and bleeding". Dig. Dis. Sci. 36 (10): 1390–4. PMID 1914760. doi:10.1007/BF01296804.
Jump up ^ Baska RS, Moses FM, Deuster PA (August 1990). "Cimetidine reduces running-associated gastrointestinal bleeding. A prospective observation". Dig. Dis. Sci. 35 (8): 956–60. PMID 2384041. doi:10.1007/BF01537243.
Jump up ^ Quintero, E. (2009). "¿Test químico o test inmunológico para la detección de sangre oculta en heces en el cribado del cáncer colorrectal?". Gastroenterología y Hepatología. 32 (8): 565–576. PMID 19577340. doi:10.1016/j.gastrohep.2009.01.179.
^ Jump up to: a b Rex, Douglas K.; Johnson, David A.; Anderson, Joseph C.; Schoenfeld, Phillip S.; Burke, Carol A.; Inadom, John M. (24 Feb 2009). "American College of Gastroenterology Guidelines for Colorectal Cancer Screening 2008" (PDF). Am J Gastroenterol (advance online publication). 104: 739–50. PMID 19240699. doi:10.1038/ajg.2009.104.
Jump up ^ Colorectal Cancer http://patients.gi.org/topics/colorectal-cancer
Jump up ^ Young GP, Cole SR (March 2009). "Which fecal occult blood test is best to screen for colorectal cancer?". Nat Clin Pract Gastroenterol Hepatol. 6 (3): 140–41. PMID 19174764. doi:10.1038/ncpgasthep1358.
Jump up ^ Quintero E (October 2009). "[Chemical or immunological tests for the detection of fecal occult blood in colorectal cancer screening?]". Gastroenterol Hepatol (in Spanish). 32 (8): 565–76. PMID 19577340. doi:10.1016/j.gastrohep.2009.01.179.
Jump up ^ Berchi C, Bouvier V, Réaud JM, Launoy G (March 2004). "Cost-effectiveness analysis of two strategies for mass screening for colorectal cancer in France". Health Econ. 13 (3): 227–38. PMID 14981648. doi:10.1002/hec.819.
Jump up ^ Kuriyama M, Kato J, Takemoto K, Hiraoka S, Okada H, Yamamoto K (March 2010). "Prediction of flare-ups of ulcerative colitis using quantitative immunochemical fecal occult blood test". World J. Gastroenterol. 16 (9): 1110–14. PMC 2835788  . PMID 20205282. doi:10.3748/wjg.v16.i9.1110.
Jump up ^ Rockey DC (July 1999). "Occult gastrointestinal bleeding". N. Engl. J. Med. 341 (1): 38–46. PMID 10387941. doi:10.1056/NEJM199907013410107.
Jump up ^ "Diagnostic Tests — Fecal Occult Blood Test". Retrieved 2007-07-18.
Jump up ^ Sheng JQ; Li SR; Wu ZT; et al. (August 2009). "Transferrin dipstick as a potential novel test for colon cancer screening: a comparative study with immuno fecal occult blood test" (PDF). Cancer Epidemiol. Biomarkers Prev. 18 (8): 2182–85. PMID 19661074. doi:10.1158/1055-9965.EPI-09-0309.
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Jump up ^ Ahlquist DA, McGill DB, Schwartz S, Taylor WF, Owen RA (May 1985). "Fecal blood levels in health and disease. A study using HemoQuant". N. Engl. J. Med. 312 (22): 1422–8. PMID 3873009. doi:10.1056/NEJM198505303122204.
Jump up ^ Dybdahl JH, Daae LN, Larsen S (1981). "Occult faecal blood loss determined by chemical tests and a 51 Cr method". Scand. J. Gastroenterol. 16 (2): 245–52. PMID 7313535. doi:10.3109/00365528109181963.
Jump up ^ St John DJ, Young GP (April 1978). "Evaluation of radiochromium blood loss studies in unexplained iron-deficiency anaemia". Aust N Z J Med. 8 (2): 121–6. PMID 307949. doi:10.1111/j.1445-5994.1978.tb04496.x.
Jump up ^ Schiff L, Stevens RJ, Shapiro N, et al. Observations on the oral administration of citrate blood in man. Am J Med Sci 1942; 203: 409.
Jump up ^ "What Does a Positive Fecal Occult Blood Test Mean? – B01". Retrieved 2007-07-18.
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Jump up ^ "Screening average risk patients for colorectal cancer – B01". Retrieved 2007-10-25.
Jump up ^ Harewood GC, McConnell JP, Harrington JJ, Mahoney DW, Ahlquist DA (January 2002). "Detection of occult upper gastrointestinal tract bleeding: performance differences in fecal occult blood tests". Mayo Clin. Proc. 77 (1): 23–28. PMID 11794453. doi:10.4065/77.1.23.
Jump up ^ Title etc http://www.mayomedicallaboratories.com/test-catalog/Overview/9220 acc on etc
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External links[edit]
FOBT Overview at Mayo Clinic
Overview at Cleveland Clinic
ColonCancerCheck including fact sheets in 24 languages at Ontario Ministry of Health and Long-Term Care
Burt RW (September 2010). "Colorectal cancer screening". Curr Opin Gastroenterol. 26: 466–70. PMID 20664346. doi:10.1097/MOG.0b013e32833d1733.
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