Hemoccult

Stool guaiac test
Medical diagnostics
Guaiac cards and bottle of developer that contains hydrogen peroxide
MedlinePlus	003393
HCPCS-L2	G0394
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The stool guaiac test or guaiac fecal occult blood test (gFOBT) is one of several methods that detects the presence of fecal occult blood (blood invisible in the feces). The test involves placing a faecal sample on guaiac paper (containing a phenolic compound, alpha-guaiaconic acid, extracted from the wood resin of Guaiacum trees) and applying hydrogen peroxide which, in the presence of blood, yields a blue reaction product within seconds.

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 (FIT). 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%. With this lower efficacy, it was not always cost effective to screen a large population with gFOBT.

The stool guaiac test involves fasting from iron supplements, red meat (the blood it contains can turn the test positive), certain vegetables (which contain a chemical with peroxidase properties that can turn the test positive), and vitamin C and citrus fruits (which can turn the test falsely negative) for a period of time before the test. It has been suggested that cucumber, cauliflower and horseradish, and often other vegetables, should be avoided for three days before the test.

In testing, feces are applied to a thick piece of paper attached to a thin film coated with guaiac. Either the patient or medical professional smears a small fecal sample on to the film. The fecal sample is obtained by catching the stool and transferring a sample with an applicator. Digital rectal examination specimens are also used but this method is discouraged for colorectal cancer screening due to very poor performance characteristics.

Both sides of the test card can be peeled open, to access the inner guaiac paper. One side of the card is marked for application of the stool and the other is for the developer fluid.

After applying the feces, one or two drops of hydrogen peroxide are then dripped on to the other side of the film, and it is observed for a rapid blue color change.

When the hydrogen peroxide is dripped on to the guaiac paper, it oxidizes the alpha-guaiaconic acid to a blue colored quinone. Normally, when no blood and no peroxidases or catalases from vegetables are present, this oxidation occurs very slowly. Heme, a component of hemoglobin found in blood, catalyzes this reaction, giving a result in about two seconds. Therefore, a positive test result is one where there is a quick and intense blue color change of the film.