Antiemetics improve the tolerance of polyethylene glycol for colonoscopy preparation

Abstract

Background: Bowel preparation is essential to the success of colonoscopy. However, many patients cannot finish the preparation due to nausea and vomiting when taking polyethylene glycol (PEG). Dopamine-2 receptor antagonists, such as domperidone and sulpiride, are classical antiemetic drugs. This study aimed to explore the effect of domperidone and sulpiride on reducing the discomforts associated with PEG. Methods: Patients scheduled for colonoscopy were enrolled and randomly allocated into 3 groups. Patients in the domperidone group (Dom group) or sulpiride group (Sul group) took 2 doses of domperidone or sulpiride before PEG. Patients in the control group (Con group) followed the regular routine of PEG. Discomforts during bowel preparation and the quality of bowel preparation were assessed. Results: A total of 306 patients were enrolled. The participants in the Dom group and Sul group completed PEG better and had fewer abdominal discomforts than those in the Con group. The severity of nausea and abdominal fullness was lower in the Dom group and Sul group. The quality of bowel preparation was better in the Dom group and Sul group than Con group. Conclusions: Domperidone and sulpiride could reduce the PEG-related discomfort and improve the quality of bowel preparation. This method may be a promising way to improve the satisfaction of bowel preparation for both patients and endoscopists.

Management of Patients With Acute Lower Gastrointestinal Bleeding: An Updated ACG Guideline

“…There are limited data on additional adjunctive techniques to improve tolerability of bowel preparation for patients undergoing inpatient colonoscopy, such as use of prokinetic or antiemetic drugs. In a RCT evaluating the efficacy of antiemetics before a split-dose 3 L PEG preparation, the use of supplemental domperidone and sulpiride was found to be associated with higher completion of PEG, reduced abdominal discomfort, and higher Boston Bowel Preparation Scale scores compared with the control group (153). Further data are needed, particularly because these medications are not routinely available or used in the United States.…”

Bowel Preparation for Pediatric Colonoscopy

“…A RCT of 308 adult patients receiving PEG for bowel preparation found that D2 receptor antagonists (domperidone and sulpiride) were associated with less abdominal discomfort. Similar studies are needed in pediatrics cohorts, especially in the context of increasing use of PEG without electrolytes ( 22 ).…”