Evaluation of Patient Tolerance and Small-Bowel Distention With a New Small-Bowel Distending Agent for Enterography

Abstract

A flavored beverage containing a thickening agent has a similar side effect profile and results in equivalent small-bowel distention compared with a low-Hounsfield-value barium suspension, but subjects rate taste and their willingness to repeat the drinking protocol higher for this new agent.

Comparison of Two Neutral Oral Contrast Agents in Pediatric Patients: A Prospective Randomized Study

“…This may relate, in part, to significantly higher taste and texture scores for Breeza versus the barium sulfate suspension and may reflect superior patient acceptance and tolerability of the flavored beverage. Our study supports the results of Kolbe et al (7), who showed that Breeza had a preferred taste to barium sulfate suspension in adult volunteers. The observation that four of eight (50%) patients who attempted an oral contrast rescue in our study could ultimately ingest the total prescribed volume of oral contrast material provides additional evidence that Breeza may have better patient acceptance and tolerability than does the barium sulfate suspension.…”

“…Two neutral oral contrast agents are commercially available in the United States: a berry-flavored 0.1% low-density barium sulfate suspension (VoLumen; Bracco Diagnostics, Milan, Italy) and a lemon-lime flavored beverage for neutral abdominal/pelvic imaging (Breeza; Beekley Medical, Bristol, Conn). Barium sulfate suspension, which also contains sorbitol and a thickening agent, has been used in pediatric and adult patients undergoing CT enterography and MR enterography for more than a decade, whereas Breeza, which contains sorbitol and mannitol as well as a thickening agent, has only recently become available for use (7). A small study in adult volunteers (n = 10; mean age, 29 years) showed that the two contrast agents perform similarly with regard to small bowel distention; however, patients rated taste and willingness to repeat the drinking protocol as higher for Breeza (7).…”

“…Barium sulfate suspension, which also contains sorbitol and a thickening agent, has been used in pediatric and adult patients undergoing CT enterography and MR enterography for more than a decade, whereas Breeza, which contains sorbitol and mannitol as well as a thickening agent, has only recently become available for use (7). A small study in adult volunteers (n = 10; mean age, 29 years) showed that the two contrast agents perform similarly with regard to small bowel distention; however, patients rated taste and willingness to repeat the drinking protocol as higher for Breeza (7). To our knowledge, there are no studies comparing these neutral oral contrast agents in children and adolescents or in pediatric patients suspected of having or known to have inflammatory bowel disease.…”

Which MRI Score and Technique Should Be Used for Assessing Crohn’s Disease Activity?

“…Several oral contrast agents are available for MRE that allow for improving the detection of wall thickenings, fistulas, abscesses, masses, and other mural abnormalities [26][27][28][29]. However, the intake of these preparations is poorly tolerated by patients due to their significant volume (up to two liters of preparation depending on the protocols), their taste, and their possible adverse events (nausea, vomiting, abdominal pain, diarrhea, and rarely, paradoxical constipation) [30]. The introduction of MRI with diffusion-weighted imaging (DWI), a specialized MRI technique, has changed the assessment of CD patients.…”

Invited Commentary on “MR Enterography of Inflammatory Bowel Disease with Endoscopic Correlation”

“…Therefore, there is a need for the continued development and improvement of small-bowel-distending agents to help avoid the need for tube-assisted enterography or enteroclysis. In our practice, we have evaluated a flavored CT oral contrast agent for MR enterography with promising results; however, further studies are necessary (4). The use of this agent has led to decreasing requests for tube placement and allowed us to perform enterography in very young patients who previously would have refused to injest small-bowel-distending agents.…”