Significance of a positive test for occult blood in stools of patients taking anti-inflammatory drugs

Abstract

Physicians often attribute positive Hemoccult card tests in patients taking anti-inflammatory drugs to the irritant effects of these drugs on the gastrointestinal (GI) tract mucosa. A study of 167 patients attending a rheumatic disease clinic showed that 145 (86.8%) were taking an antiinflammatory drug, but only 8 of these patients (4.8%) had positive tests for occult blood. An investigation revealed that 3 patients had neoplasms, 2 had inflammatory bowel disease, 1 had a bleeding internal hemorrhoid, 1 had a bleeding diverticulum and 1 had peptide ulcer disease. Antiinflammatory agents appear to have caused or contributed to the GI tract bleeding only in the patient with peptide ulcer disease. The Hemoccult card test apparently is usually not positive in patients receiving antiinflammatory medications. Accordingly, physicians should not attribute a positive Hemoccult card test to these drugs until other appropriate studies have ruled out the existence of underlying GI tract lesions.