{
  "abstract": "Introduction In patients with a positive faecal immunochemical test (FIT) but no significant abnormality on lower gastrointestinal (GI) investigation, upper GI investigation is not routinely recommended. Using UK primary care records, we examined the incidence of oesophageal and gastric (upper GI) cancer following a positive FIT with no explanation on lower GI investigation and associated factors.Methods Clinical Practice Research Datalink was used to identify all patients who have had a positive FIT from 01/07/2017-28/12/2023. Upper GI symptoms and iron-deficiency anaemia recorded six months before or after a positive FIT were assessed. Patients with colorectal cancer, inflammatory bowel disease, or colonic polyps were excluded. Multivariable logistic regression analysis examined associations between upper GI cancer diagnosed following a positive FIT, demographics, iron deficiency anaemia and symptoms.Results Of 165,397 patients with a positive FIT, 153,990 remained following exclusions for a definite or possible lower GI cause. Within three years, 279 developed upper GI cancer (140 oesophageal cancer and 139 gastric cancer). 89.6% developed upper GI cancer within the first year following a positive FIT.A multivariable logistic regression model (table 1) revealed that men (OR 2.60, 95% CI 2.01-3.38, p<0.001) and ages 71-90 (OR 4.05, 95%CI 1.23-19.99, p=0.025) were associated with upper GI cancer in this context. All upper GI symptoms were associated with upper GI cancer. However, the strongest association was with the alarm symptoms of dysphagia (OR 7.53, 95%CI 5.04-11.27, p<0.001) and nausea or vomiting (OR 3.63, 95%CI 2.35-5.61, p<0.001), and also iron deficiency anaemia (OR 3.45, 95%CI 2.53-4.71, p<0.001).Conclusions The incidence of upper GI cancer in the year following a positive FIT test without a subsequent diagnosis of CRC, IBD or polyps was low at 2.28 per 1000 person years. However, enquiring about upper GI symptoms, particularly alarm symptoms, and assessing for iron deficiency anaemia in this cohort of patients should help guide selection of patients for upper GI endoscopy.Abstract P16 Table 1Logistic regression analysis of patient level factors associated with upper GI cancer following a positive FIT and no colorectal cancer, inflammatory bowel disease or polyps on lower GI investigationAdjusted OR95% CIpMen2.602.01–3.38<0.001Age baseline 16-30Age 31–500.590.12–2.790.505Age 51–702.270.55–9.290.25Age 71–90 4.951.23–19.990.025Dysphagia7.535.03–11.27<0.001Nausea/vomiting3.632.35–5.61<0.001Dyspepsia2.451.41–4.270.002Weight loss1.741.20–2.520.003Reflux2.131.30-3.480.003Abdominal pain1.501.10-2.050.010Iron deficiency anaemia present3.452.53–4.71<0.001Hb not checked 6m pre/post FIT1.961.39-2.77<0.001",
  "authors": [
    {
      "affiliations": [
        "Department of Applied Health Sciences, University of Birmingham, Birmingham, United Kingdom",
        "Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom"
      ],
      "name": "Shahd Mohamed"
    },
    {
      "affiliations": [
        "Department of Applied Health Sciences, University of Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Nicola Adderley"
    },
    {
      "affiliations": [
        "Sandwell and West Birmingham NHS Trust, Birmingham, United Kingdom",
        "Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom"
      ],
      "name": "Nigel Trudgill"
    }
  ],
  "title": "P16 The incidence of upper gastrointestinal cancer in patients with a positive faecal immunochemical test and unremarkable lower gastrointestinal investigation",
  "uid": "50672ef8-a02a-5ba3-b8d2-d05e2fde3198"
}