Quality of bowel preparation in patients with inflammatory bowel disease undergoing colonoscopy: What factors to consider?

Gravina, Antonietta Gerarda; Pellegrino, Raffaele; Romeo, Mario; Palladino, Giovanna; Cipullo, Marina; Iadanza, Giorgia; Olivieri, Simone; Zagaria, Giuseppe; Gennaro, Nicola De; Santonastaso, Antonio; Romano, Marco; Federico, Alessandro Di

doi:10.4253/wjge.v15.i3.133

Cited by 20 publications

(14 citation statements)

References 77 publications

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“…According to the Montreal classification ( 21 ), in this study, nonstenotic and nonpenetrating (B1) were defined as inflammatory disease behavior, and stenotic (B2) and penetrating (B3) were defined as complex disease behavior. In addition, adequate bowel preparation is crucial for successful endoscopy in patients with CD ( 22 ), and all patients in this study underwent adequate bowel preparation before endoscopic examination. An experienced gastroenterologist assessed the ulcer size, area, extent of lesion, luminal stenosis and degree by endoscopy, and scored each segment of the ileum and colon according to SES-CD.…”

Section: Methodsmentioning

confidence: 99%

Body composition parameters correlate with the endoscopic severity in Crohn’s disease patients treated with infliximab

Tang,

Xie,

et al. 2023

Front. Nutr.

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BackgroundThe disease activity status and behavior of Crohn’s disease (CD) can reflect the severity of the disease, and changes in body composition are common in CD patients.AimsThe aim of this study was to investigate the relationship between body composition parameters and disease severity in CD patients treated with infliximab (IFX).MethodsPatients with CD assessed with the simple endoscopic score (SES-CD) and were treated with IFX were retrospectively collected, and body composition parameters at the level of the 3rd lumbar vertebrae were calculated from computed tomography (CT) scans of the patients. The correlation of patients’ body composition parameters with disease activity status and disease behavior was analyzed, and the diagnostic value of the relevant parameters was assessed using receiver operating characteristic (ROC) curves.ResultsA total of 106 patients were included in this study. There were significant differences in the subcutaneous adiposity index (SAI) (p = 0.010), the visceral adiposity index (VAI) (p < 0.001), the skeletal muscle mass index (SMI) (p < 0.001), and decreased skeletal muscle mass (p < 0.001) among patients with different activity status. After Spearman and multivariate regression analysis, SAI (p = 0.006 and p = 0.001), VAI (p < 0.001 and p < 0.001), and SMI (p < 0.001and p = 0.007) were identified as independent correlates of disease activity status (both disease activity and moderate-to-severe activity), with disease activity status independently positively correlated with SAI and SMI and independently negatively correlated with VAI. In determining the disease activity and moderate-to-severe activity status, SMI performed best relative to SAI and VAI, with areas under the ROC curve of 0.865 and 0.801, respectively. SAI (p = 0.015), SMI (p = 0.011) and decreased skeletal muscle mass (p = 0.027) were significantly different between different disease behavior groups (inflammatory disease behavior group, complex disease behavior group) but were not independent correlates (p > 0.05).ConclusionBody composition parameters of CD patients treated with IFX correlate with the endoscopic disease severity, and SMI can be used as a reliable indicator of disease activity status.

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Section: Methodsmentioning

confidence: 99%

Body composition parameters correlate with the endoscopic severity in Crohn’s disease patients treated with infliximab

Tang,

Xie,

et al. 2023

Front. Nutr.

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“…Quality colonoscopy is essential for the diagnostic algorithm of patients with suspected CMV infection, and it must be performed under conditions of adequate bowel preparation. This can be achieved either using oral solutions or using enemas, especially in cases of severe acute ulcerative colitis where rectoscopy allows us to perform sampling for CMV search and rapid endoscopic Mayo score evaluation [ 50 ]. The characteristic features of CMV infection in these samples include cytomegalic cells, intranuclear inclusions, and characteristic nuclear and cytoplasmic inclusions [ 49 ].…”

Section: Methods For Diagnosis Of CMV Infectionmentioning

confidence: 99%

Cytomegalovirus Infection: An Underrated Target in Inflammatory Bowel Disease Treatment

Maresca,

Varca,

Di Vincenzo

et al. 2023

JCM

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CMV infection is still a matter of concern in IBD patients, especially regarding the disease’s relapse management. Why IBD patients, particularly those affected by ulcerative colitis, are more susceptible to CMV reactivation is not totally explained, although a weakened immune system could be the reason. Various techniques, ranging from serology to histology, can be employed to detect intestinal CMV infection; however, there is currently disagreement in the literature regarding the most effective diagnostic test. Furthermore, CMV involvement in steroid resistance has been broadly discussed, but whether CMV infection is a cause or consequence of the disease severity and, consequently, steroid refractoriness is still debated. Its potential contribution to the lack of response to advanced therapy and small molecules must be more valued and wholly explored. In this review, we look at the actual literature on CMV in IBD patients, and we suggest a pragmatic algorithm for clinical practice management of CMV infection.

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“…In a subsequent trial targeting patients with inactive IBD, Kim et al [ 19 ] reported a lower bubble score rate in the novel oral sulphate table preparations and higher palatability (including a willingness to reuse the preparation for subsequent colonoscopy) than the PEG-ascorbate comparison. The problem of bubbles is another technical aspect to consider when discussing mucosal visibility, so much so that the use of simethicone for this purpose is bleached out by European guidelines and also found beneficial for IBD[ 5 , 8 ].…”

Section: What Profile Do Non-peg Solutions Have In Ibd?mentioning

confidence: 99%

“…This choice, while not axiomatically pursuing the goal of palatability, is necessary because most studies in IBD are available for this type of preparation and because safety studies have shown a significantly better safety profile for PEG solutions than for non-PEG-based solutions ( e.g. , magnesium citrate plus picosulphate, oral sulfate solutions)[ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Emerging space for non-polyethene-glycol bowel preparations in inflammatory bowel disease-related colonoscopy: Veering toward better adherence and palatability

Pellegrino,

Gravina

2023

World J Gastroenterol

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Patients with inflammatory bowel diseases (IBDs) require repeated endoscopic evaluations over time by colonoscopy to weigh disease activity but also for different and additional indications (e.g. , evaluation of postoperative recurrence, colorectal cancer surveillance). Colonoscopy, however, requires adequate bowel preparation to be of quality. The latter is achieved as long as the patient takes a certain amount of product to have a number of bowel movements suitable to clean the colon and allow optimal visualization of the mucosa during endoscopy. However, significant guidelines recommend preparations for patients with IBD not excelling in palatability. This recommendation originates from the fact that most of the studies conducted on bowel preparations in patients with IBD have been done with isosmolar preparations based on polyethylene glycol (PEG), for which, therefore, more safety data exist. As a result, the low-volume non-PEG preparations (e.g. , magnesium citrate plus picosulphate, oral sulphate solutions) have been set aside for the whole range of warnings to be heeded because of their hyperosmolarity. New studies, however, are emerging, leaning in overall for a paradigm shift in this matter. Indeed, such non-PEG preparations seem to show a particularly encouraging and engaging safety profile when considering their broad potential for tolerability and patient preference. Indeed, such evidence is insufficient to indicate such preparations in all patients with IBD but may pave the way for those with remission or well-controlled disease. This article summarizes the central studies conducted in IBD settings using non-PEG preparations by discussing their results.

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Quality of bowel preparation in patients with inflammatory bowel disease undergoing colonoscopy: What factors to consider?

Cited by 20 publications

References 77 publications

Body composition parameters correlate with the endoscopic severity in Crohn’s disease patients treated with infliximab

Body composition parameters correlate with the endoscopic severity in Crohn’s disease patients treated with infliximab

Cytomegalovirus Infection: An Underrated Target in Inflammatory Bowel Disease Treatment

Emerging space for non-polyethene-glycol bowel preparations in inflammatory bowel disease-related colonoscopy: Veering toward better adherence and palatability

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