Digestive Diseases and Sciences

, Volume 40, Issue 12, pp 2522–2525 | Cite as

Fecal α1-antitrypsin detection of colorectal neoplasia

An evaluation using hemoquant
  • Alex Moran
  • Mike Robinson
  • Nigel Lawson
  • Julie Stanley
  • Alan F. Jones
  • Jack D. Hardcastle
Gastrointestinal Oncology

Abstract

Fecal α1-antitrypsin measurement may be of value for the detection of coloreactal neoplasia and is compared with the HemoQuant test in 119 subjects with either a screen-positive Hemoccult result (N=78) or iron-deficiency anaemia (N=41). Nineteen patients were found to have coloreactal cancer, 35 had colorectal adenomatous polyps, 5 had inflammatory bowel disease, and 60 had no detected cause of occult blood loss. Of the cancer patients, 63% (12/19) were detected by fecal α1-antitrypsin, and 63% (12/19) by HemoQuant. Of the adenomas >1 cm in diameter 33% (7/23) were detected by fecal α1-antitrypsin and 26% (6/23) by HemoQuant. There was a poor correlation between fecal α1-antitrypsin, and HemoQuant results for colorectal cancers (r=0.37,P>0.05), and combining the tests, the sensitivity for colorectal cancer was incerased to 84% (16/19). Fecal proteins loss, as measured using α1-antitrypsin, appears to involve largely different mechanisms from that of blood loss from colorectal cancers.

Key Words

α1-antitrypsin occult blood colorectal neoplasms iron-deficiency anemia 

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References

  1. 1.
    Greegor, DH: Diagnosis of large bowel cancer in the asymptomatic patient. JAMA 101:943–945, 1967Google Scholar
  2. 2.
    Winawer, SJ, Andrews, M, Flehinge, B, Sherlock P, Schottenfeld D, Miller DG Progress report on controlled trial of faecal occult blood testing for the detection of colorectal neoplasia. Cancer 45:2959–2964, 1980Google Scholar
  3. 3.
    Hardcastle JD, Farands PA, Balfour TW, Chamberlain J: Controlled trial of faecal occult blood screening in the detection of colorectal cancer. Lancet 2:1–4, 1983Google Scholar
  4. 4.
    Mandel JS, Bond JH, Church TR, Snover DC, Bradley GM, Schuman LM, Ederer F: Reducing mortality from colorectal cancer by screening for fecal occult blood. N Eng J Med 328:1365–1371, 1993Google Scholar
  5. 5.
    Weil J, Langman MJS: Screening for gastrointestinal cancer: An epidemiological review. Gut 32:220–224, 1991Google Scholar
  6. 6.
    Moran A, Radley S, Neoptolemos J, Jones AF, Asquith P: Detection of colorectal cancer by faecal alpha-1-antitrypsin. Ann Clin Biochem 30:28–33, 1993Google Scholar
  7. 7.
    Ahlquist DA, Klee GG, McGill DB, Ellefson RD. Colorectal cancer in the practice setting. Arch Intern Med 150:1041–1045, 1990Google Scholar
  8. 8.
    Doran J, Hardcastle JD: Bleeding patterns in colorectal cancer: The effect of aspirin and the implications for faecal occult blood testing. Br J Surg 69:711–713, 1982Google Scholar
  9. 9.
    Morrow RJ, Lawson N, Hussaini SH, Asquith P:A comparison of faecal haemoglobin, albumin and alpha-1-antitrypsin in the detection of gastro-intestinal bleedings. Ann Clin Biochem 27:208–212, 1990Google Scholar
  10. 10.
    Perlmutter DH, Daniels JD, Auerbach HS, De Schryver-Kecskemeti K, Winter HS, Alpers DH: The alpha-1-antitrypsin gene is expressed in a human intestinal epithelial cell line. J Biol Chem 264:9485–9490, 1989Google Scholar
  11. 11.
    Kataoka H, Nabeshima K, Komada N, Koono M: New human colorectal carcionma cell-lines that secrete proteinase inhibitorsin vitro. Virchows Arch B Cell Pathol 57:157–165, 1989Google Scholar
  12. 12.
    Florent C, L'Hirondel C, Desmazures C, Aymes C, Bernier JJ: Intestinal clearance of alpha-1-antitrypsin. A sensitive method for the detection of protein-losing enteropathy. Gastroenterology 81:777–780, 1981Google Scholar
  13. 13.
    Moran A, Panos MZ, Jones AF: Validity of alpha-1-antitrypsin as a test of enteric protein loss—upper gastro-intestinal origins. Gut 36:A63, 1995Google Scholar
  14. 14.
    Hardcastle JD, Thomas WM, Chamberlain J, Pye G, Sheffield J, James PD: Randomised, controlled trial of faecal occult blood screening for colorectal cancer. Lancet 1:1160–1164, 1989Google Scholar
  15. 15.
    Ahlquist DA, McGill DB, Schartz S, Taylor WF, Ellefson BS, Owen RA: HemoQuant, a new quantitative assay for faecal haemoglobin. Ann Intern Med 101:297–302, 1984Google Scholar
  16. 16.
    Schwartz S, Dahl J, Ellefson M, Ahlquist D: The “Hemoquant” test: A specific and quantitative determination of haem (haemoglobin) in faeces and other materials. Clin Chem 29:2061–2067, 1983Google Scholar
  17. 17.
    Ahlquist DA, Wiend HS, Moertal CG, McGill DB, Loprinzi CL, O'Connell MJ, Maillard JA, Gerstner JB, Pandya K, Ellefson RD: Accuracy of faecal occult blood screening for colorectal neoplasia. JAMA 269:1262–1267, 1993Google Scholar
  18. 18.
    Ahlquist DA, McGill DB, Fleming JL, Schwartz S, Wiend HS, Rubin J, Moertel CG: Parterns of occult bleeding in asymptomatic colorectal cancer. Cancer 63:1826–1830, 1989Google Scholar
  19. 19.
    Stroehlein JR, Fairbanks VF, McGill DB, Go VLW: Hemoccult detection of faecal occult blood quantitated by radioassay. Am J Dig Dis 21:841–844, 1976Google Scholar
  20. 20.
    Ahlquist DA, McGill DB, Schwartz S, Taylor WF, Owen RA: Faecal blood levels in health and disease. N Engl J Med 312:1422–1428, 1985Google Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • Alex Moran
    • 1
    • 2
    • 3
  • Mike Robinson
    • 1
    • 2
    • 3
  • Nigel Lawson
    • 1
    • 2
    • 3
  • Julie Stanley
    • 1
    • 2
    • 3
  • Alan F. Jones
    • 1
    • 2
    • 3
  • Jack D. Hardcastle
    • 1
    • 2
    • 3
  1. 1.Departments of Gastroenterology and Clinical ChemistryBirmingham Heartlands HospitalUK
  2. 2.Department of Clinical ChemistryCity HospitalNottinghamUK
  3. 3.Department of SurgeryQueen's Medical CentreNottinghamUK

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