Population Screening for Colorectal Cancer Means Getting FIT: The Past, Present, and Future of Colorectal Cancer Screening Using the Fecal Immunochemical Test for Hemoglobin (FIT)

Fecal immunochemical tests for hemoglobin (FIT) are changing the manner in which colorectal cancer (CRC) is screened. Although these tests are being performed worldwide, why is this test different from its predecessors? What evidence supports its adoption? How can this evidence best be used? This review addresses these questions and provides an understanding of FIT theory and practices to expedite international efforts to implement the use of FIT in CRC screening.

Antibiotic-associated diarrhoea and colitis due to clostridium difficile

The majority of cases of antibiotic-associated colitis whether pseudomembranous or non-specific in type are caused by clostridium difficile. This infection almost always occurs in association with antibiotic therapy. It is considered that such therapy perturbs colonic microflora that normally suppress the pathogen thus allowing it to colonize the colon. There it causes tissue damage and diarrhea by production of cyto- and enterotoxins. The spectrum of illness ranges from a few loose stools to fulminant colitis which may be complicated by toxic megacolon or perforation. Approximately 50% of patients have self-limiting disease which does not warrant specific therapy. However orally administered vancomycin or bacitracin are of proven value in moderate to severe cases where disease dose not resolve spontaneously. Relapse can occur in 25-50% of specifically treated patients. The mechanisms by which relapse occurs are not fully understood but do appear to include reinfection in a susceptible colon as well as initially inadequate clearance of the organism from stools. Lactobacilli are known to suppress growth of C. difficile in vitro. Controlled clinical studies are warranted to determine if deliberate attempts to suppress colonization by the pathogen with bacteria such as lactobacilli are of therapeutic benefit. The incidence, morbidity and mortality of this iatrogenic condition can be minimized by rational antibiotic therapy