qFIT in Symptomatic Patients

In September 2018, Greater Glasgow and Clyde introduced the Quantitative Faecal Immunochemical Test, or qFIT, as part of the investigation pathway for patients with symptomatic bowel disease. qFIT is a quantitative immunochemical test that is specific for human globin released from broken down red blood cells. :contentReference[oaicite:1]{index=1}

Because it detects human globin, the test is not affected by upper gastrointestinal pathology, diet, or medication in the way older faecal occult blood tests could be. :contentReference[oaicite:2]{index=2}

qFIT for symptomatic patients with bowel symptoms.

qFIT measures the amount of blood in the stool and gives a quantitative result. The test relies on partial breakdown of red blood cells to release the globin protein that the test detects. :contentReference[oaicite:3]{index=3}

Because of that, the test may sometimes be negative in intermittent benign anorectal bleeding where blood is passed as whole cells rather than broken down blood. :contentReference[oaicite:4]{index=4}

The sample is collected using a single stool sample with a dedicated collection device called a “picker”, which should be returned to the GP practice within seven days. :contentReference[oaicite:5]{index=5}

qFIT is the same test as the FIT test used in bowel screening, but the threshold for a positive result is different. In Scotland’s bowel screening programme, a value of 80 or higher is treated as positive and patients are invited for screening colonoscopy. In symptomatic patients, the positive threshold is much lower at 10 or higher. :contentReference[oaicite:6]{index=6}

Higher values are considered more significant and suggest a greater chance of an important underlying problem such as a significant polyp or bowel cancer. :contentReference[oaicite:7]{index=7}

The page states that qFIT has a better negative predictive value than colonoscopy when the aim is to exclude significant colorectal pathology such as adenomas greater than 1 cm, inflammatory bowel disease, and cancer. :contentReference[oaicite:8]{index=8}

• qFIT less than 10 with a normal full blood count: around 1 in 1000 chance of colorectal malignancy
• Negative predictive value for any significant pathology: approximately 94%
• qFIT 10 to 400: approximately 20% chance of significant pathology
• qFIT over 400: greater than 50% chance of significant pathology

These figures are presented on the GCC page as a guide to how the test is interpreted in symptomatic patients. :contentReference[oaicite:9]{index=9}

The page notes that patients with fresh rectal bleeding may occasionally have a negative qFIT result but still have underlying problems such as polyps or adenomas. However, it also states that it is very unlikely that a patient with cancer will have a negative result. :contentReference[oaicite:10]{index=10}

Because of this limitation, the page says NICE were not yet recommending qFIT for use in rectal bleeding at the time the page was written. It adds that if symptoms persist despite a negative result, patients should at least be considered for lower rectal assessment with sigmoidoscopy, even if colonoscopy may not be required. :contentReference[oaicite:11]{index=11}

The page says it was expected that GPs would use qFIT for most patients with symptomatic bowel disease before referral to secondary care. Pilot study experience, including patients from Dundee, suggested uptake in primary care was rapid. In the first three years after introduction, almost all patients referred to colorectal services with bowel problems had a qFIT performed by their GP. :contentReference[oaicite:13]{index=13}

The page further says qFIT may reduce the need for colonoscopy and may also reduce the number of new referrals to gastroenterology and surgical services. It presents qFIT as offering the possibility of rapid and sensitive assessment of patients with bowel symptoms. :contentReference[oaicite:14]{index=14}

A negative result, in the absence of other symptoms or signs, means GPs may be able to reassure patients without necessarily referring them to secondary care. :contentReference[oaicite:15]{index=15}

The GCC page includes an external information source for further reading on faecal immunochemical testing. :contentReference[oaicite:16]{index=16}

qFIT for symptomatic patients is also identified on the page as a January 2019 information article. :contentReference[oaicite:17]{index=17}