Oral Lactulose vs. Polyethylene Glycol for Bowel Preparation in Colonoscopy: A Randomized Controlled Study

Abstract

BackgroundColonoscopy is the method of choice to evaluate colonic mucosa and the distal ileum, allowing the diagnosis and treatment of many diseases. Appropriate bowel preparation necessitates the use of laxative medications, preferentially by oral administration. These include polyethylene glycol (PEG), sodium picosulfate, and sodium phosphate (NaP). Lactulose, a semi-synthetic derivative of lactose, undergoes fermentation, acidifying the gut environment, stimulates intestinal motility, and increases osmotic pressure within the lumen of the colon. MethodsIn this prospective randomized controlled study, we analyzed 40 patients who presented with symptomatic bleeding per rectum and underwent bowel preparation either with lactulose or polyethylene glycol for colonoscopy. The quality of bowel preparation and other variables like palatability, discomfort, and electrolyte levels were analyzed. ResultsThe majority of the patients (90%) were comfortable with the taste of lactulose solution, whereas the PEG group patients (55%) were equally divided on its palatability. On lactulose consumption, 40% of patients reported nausea/vomiting and around 10% of patients complained of abdominal discomfort. Serum sodium levels showed insignificant changes from 4.33 ± 0.07 mEq/L to 4.21 ± 0.18 mEq/L while potassium also remained similar from 4.26 ± 0.03 mEq/L to 4.22 ± 0.17 mEq/L. The mean Boston Bowel Preparation Score (BBPS) in patients who received lactulose solution was 6.25 ± 0.786 and in those who received PEG solution, it was 6.35 ± 0.813 (P-value = 0.59). ConclusionsLactulose is a significantly more palatable form of bowel preparation and causes minor discomfort. It has a good bowel cleansing action comparable to PEG without causing any hemodynamic changes. It can be considered a cheaper and safe alternative for bowel preparation in colonoscopy in low-resource settings.

Lactulose vs Polyethylene Glycol for Bowel Preparation: A Single-Center, Prospective, Randomized Controlled Study Based on BMI

“…The findings demonstrate that, in comparison with the PEG-alone control group, the combination can decrease patients’ pain and water intake while also improving the quality of bowel preparation. In an another study conducted by Jagdeep et al ( 30 ) in 2021, lactulose is a significantly more palatable form of bowel preparation with good bowel cleansing comparable with PEG, causing minor discomforts without causing any hemodynamic changes; Li et al ( 6 ) also reached the same conclusion, and the detection rate of intestinal lesions in the lactulose group was higher than that in the PEG group ( P < 0.05).…”

Effectiveness of Lactulose for Colonoscopy Preparation in Adults:A Meta-Analysis

“…The literature screening process is shown in Figure 1. Characteristics of the included literature 11 RCT articles were included, of which 9 were Chinese articles [7][8][9][10][11][12][13][14][15], 2 were English articles [16,17], and the publication time was between 2013 and 2021. The study country was mainly China, laxative of choice for the experimental group was lactulose, and the intervention of choice of the control group were mainly polyethylene glycol electrolyte and oral magnesium sulfate.…”

“…In terms of random allocation: 8 out of 11 included studies stated that the random allocation method was used [8, 10-14, 16, 17], the other 3 did not state their allocation method [7,9,15], with 4 of the studies [10][11][12][13] not explicitly stating their choice of random allocation method. 4 studies [8,14,16,17]specified that they used the random number table method; among them, the research by Li [16] and Jagdeep [17] have the highest quality, having used the single-blind method within the group, with a low risk of bias; the rest of the literature was not blinded; and the selective reporting of trial results and other risk indicators of bias were not reported in the literature due to their uniqueness, however, the overall quality of the literature is moderate. The methodological quality of the literature is shown in Figure 2.…”

Polyethylene glycol combined with lactulose has better efficacy than polyethylene glycol alone in bowel preparation before colonoscopy: A meta-analysis

“… 6 Recently, some studies have adopted lactulose as an intestinal cleanser, which exhibited a positive effect. 7 , 8 , 9 …”