Comparing Impacts of Different Bowel Cleansing Agents and Oral Probiotics After Cleansing On Symptom and Microbiota: a Randomized Placebo-Controlled Trial

Abstract

Background: Sodium sulfate-based purge has shown better quality of bowel preparation than polyethylene glycol (PEG) in a large retrospective study. However, its side effects and impact to gut microbiota have not been assessed. Besides, evidence from intestinal microecology that probiotics were beneficial to individuals who received bowel preparation is still lacking. The aims are to evaluate the side effects and microecological impact of two bowel cleansing agents (PEG and mirabilite), as well as the regulating effect of probiotics on microecosystem perturbed by bowel preparation.Results: Mirabilite preparation appeared superior to PEG preparation in terms of side effects, consumed time and volume of solutions. Quantitative PCR results showed that the recovery rate of total microbial load in mirabilite group was faster than that in PEG group. 16S rRNA sequencing showed that there were no significant differences in effects of two bowel cleansing agents on multiple microbiota diversity metrics. And both laxatives may affect the relative abundance of core microbiota until 28 days after bowel preparation. Probiotics supplementation was beneficial to recovery of perturbed microecosystem and the maintenance of homeostasis in the gut according to our results. Moreover, probiotics supplementation relieved abdominal symptoms and few individual events induced by bowel preparation during long-term follow-up.Conclusions: Mirabilite could be an optimal bowel cleansing agent for healthy people and can be applied broadly. Besides, probiotics are suggested to administrate after bowel cleansing as it brings multiple benefits in our study.