Systematic review and meta-analysis of colon cleansing preparations in patients with inflammatory bowel disease

Restellini, Sophie; Kherad, Omar; Bessissow, Talat; Ménard, Charles; Martel, Myriam; Tanjani, Maryam Taheri; Lakatos, László; Barkun, Alan N.

doi:10.3748/wjg.v23.i32.5994

Cited by 20 publications

(16 citation statements)

References 39 publications

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“…As aphthous ulceration has been associated with use of sodium phosphate,988 PEG-based bowel cleansing agents are commonly used in IBD. Low-volume regimens are better tolerated and bowel cleansing is non-inferior to high-volume PEG regimens 989…”

Section: Common Disease Considerationsmentioning

confidence: 99%

British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults

Lamb

Kennedy

Raine

et al. 2019

Gut

1,725

1,816

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Ulcerative colitis and Crohn’s disease are the principal forms of inflammatory bowel disease. Both represent chronic inflammation of the gastrointestinal tract, which displays heterogeneity in inflammatory and symptomatic burden between patients and within individuals over time. Optimal management relies on understanding and tailoring evidence-based interventions by clinicians in partnership with patients. This guideline for management of inflammatory bowel disease in adults over 16 years of age was developed by Stakeholders representing UK physicians (British Society of Gastroenterology), surgeons (Association of Coloproctology of Great Britain and Ireland), specialist nurses (Royal College of Nursing), paediatricians (British Society of Paediatric Gastroenterology, Hepatology and Nutrition), dietitians (British Dietetic Association), radiologists (British Society of Gastrointestinal and Abdominal Radiology), general practitioners (Primary Care Society for Gastroenterology) and patients (Crohn’s and Colitis UK). A systematic review of 88 247 publications and a Delphi consensus process involving 81 multidisciplinary clinicians and patients was undertaken to develop 168 evidence- and expert opinion-based recommendations for pharmacological, non-pharmacological and surgical interventions, as well as optimal service delivery in the management of both ulcerative colitis and Crohn’s disease. Comprehensive up-to-date guidance is provided regarding indications for, initiation and monitoring of immunosuppressive therapies, nutrition interventions, pre-, peri- and postoperative management, as well as structure and function of the multidisciplinary team and integration between primary and secondary care. Twenty research priorities to inform future clinical management are presented, alongside objective measurement of priority importance, determined by 2379 electronic survey responses from individuals living with ulcerative colitis and Crohn’s disease, including patients, their families and friends.

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Section: Common Disease Considerationsmentioning

confidence: 99%

British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults

Lamb

Kennedy

Raine

et al. 2019

Gut

1,725

1,816

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“…Limited comparative data are available for bowel preparation efficacy and tolerability in colitis. A recent 2017 meta-analysis identified four fully published comparative studies [168]; no more studies were identified after further searches. One study from the 1980s compared the use of bowel preparation regimens that would not be acceptable in contemporary practice (castor oil vs. high dose senna) [169], and one examined the use of addition of simethicone to PEG-based preparation to reduce bubbling [170].…”

Section: Patients With Inflammatory Bowel Disease (Ibd)mentioning

confidence: 99%

Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019

et al. 2019

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Main RecommendationsESGE recommends a low fiber diet on the day preceding colonoscopy.Strong recommendation, moderate quality evidence.ESGE recommends the use of enhanced instructions for bowel preparation.Strong recommendation, moderate quality evidence.ESGE suggests adding oral simethicone to bowel preparation.Weak recommendation, moderate quality evidence.ESGE recommends split-dose bowel preparation for elective colonoscopy.Strong recommendation, high quality evidence.ESGE recommends, for patients undergoing afternoon colonoscopy, a same-day bowel preparation as an acceptable alternative to split dosing.Strong recommendation, high quality evidence.ESGE recommends to start the last dose of bowel preparation within 5 hours of colonoscopy, and to complete it at least 2 hours before the beginning of the procedure.Strong recommendation, moderate quality evidence.ESGE recommends the use of high volume or low volume PEG-based regimens as well as that of non-PEG-based agents that have been clinically validated for routine bowel preparation. In patients at risk for hydroelectrolyte disturbances, the choice of laxative should be individualized.Strong recommendation, moderate quality evidence.

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“…In high-risk individuals, including those with IBD, compliance with bowel preparation is particularly critical. 29 , 30 However, the tolerability of bowel preparation agents may deter these individuals from returning as needed for screenings. 30 , 31 Missed screening colonoscopies can have negative consequences for polyp detection and long-term health.…”

Section: Discussionmentioning

confidence: 99%

“… 29 , 30 However, the tolerability of bowel preparation agents may deter these individuals from returning as needed for screenings. 30 , 31 Missed screening colonoscopies can have negative consequences for polyp detection and long-term health. 7 – 9 , 32 Rates of repeat screenings in the high-risk group in this analysis were higher for individuals using P/MC, suggesting that they were more likely to return for screening than those using other bowel preparation agents.…”

Section: Discussionmentioning

confidence: 99%

Real-world comparison of the effectiveness and safety of different bowel preparation agents

Sacks¹,

Sharma²,

Cyr³

et al. 2018

CEG

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Background and aimsProper bowel cleansing is necessary prior to colonoscopy, but poor tolerability to bowel preparation agents may increase the odds of poor cleansing and incomplete screenings. The aim of this study was to evaluate the real-world effectiveness and safety of bowel preparation agents.MethodsClaims data were extracted for individuals who had a screening colonoscopy from July 1, 2012, to June 30, 2015, were ≥18 years of age, and who could be observed ≥6 months before and ≥3 months after the screening. Data were stratified by agent class, including over-the-counter (OTC), low-volume (LV), and high-volume (HV) agents. Rates of incomplete screenings, repeat screenings, and hospitalizations were reported. Multivariate logistic regression was conducted to compare outcomes for sodium picosulfate, magnesium oxide, and citric acid (P/MC) vs other agents.ResultsOf 2.8 million individuals, 71.5% were average risk and 28.5% were high risk for colorectal cancer. Rates of use were 2.8% for P/MC, 30.1% for other LV agents, 9.4% for HV agents, and 56.6% for OTC agents. All individuals who used P/MC had significantly lower odds of incomplete screenings compared to those who used other LV agents or HV agents (P<0.05). In average-risk patients, rates of 30- and 90-day repeat screenings were highest for the P/MC group (16.7% and 23.0%, respectively) compared to other agents. Across all patient analysis groups, the rates of hospitalizations for hyponatremia or dehydration were much higher for those who used an OTC bowel preparation agent compared to those who used LV or HV agents, or P/MC.ConclusionP/MC was associated with lower rates of incomplete colonoscopy and higher rates of repeat screenings, suggesting it was better tolerated than other agents. OTC agents were associated with higher rates of hospitalizations.

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Systematic review and meta-analysis of colon cleansing preparations in patients with inflammatory bowel disease

Cited by 20 publications

References 39 publications

British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults

British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults

Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline – Update 2019

Real-world comparison of the effectiveness and safety of different bowel preparation agents

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