Tolerability of Bowel Preparation and Colonoscopy in IBD Patients: Results From a Prospective, Single-Center, Case–Control Study

Abstract

Background Endoscopy plays a fundamental role in the management of patients with inflammatory bowel disease (IBD). Aims: to prospectively evaluate the tolerability and efficacy of bowel preparation and colonoscopy in ulcerative colitis (UC) and Crohn’s disease (CD) patients compared to subjects participating in a colorectal cancer population screening program. Methods consecutive enrolment of CD and UC patients and screening subjects (SS) undergoing colonoscopy. Bowel preparation was done by split dose of 2 L PEG-ELS + simethicone. We recorded endoscopic, clinical, and demographic features; cleanliness rating using the Boston Bowel Preparation Scale (BBPS); sedation doses. Bowel-preparation tolerability, discomfort and pain during colonoscopy were assessed using a Visual Analogue Scale (VAS) from 0 to 100 mm. Results 63 UC (mean age 49.9 ± 14.9 yrs), 63 CD (mean age 44.0 ± 14.0 yrs) and 63 SS (mean age 59.9 ± 6.3) enrolled. Bowel preparation was similarly tolerated in UC, CD and SS (p=0.397). A complete colonoscopy was similarly performed in UC (59/63, 93.7%), CD (58/63, 92.1%) and SS (60/63, 95.2%) (p=0.364). The BBPS did not show significant differences between UC (6.2 ± 1.6), CD (6.1 ± 1.3) and SS (6.2 ± 1.4) (p=0.824). The need to increase sedation doses was significantly higher in CD (24/63, 38.1%) and UC (16/63, 25.4%) than in SS (4/63, 6.3%) (p<0.0001). Conclusions bowel preparation is equally tolerated and efficacious in IBD patients and in healthy screening subjects. In IBD, higher sedation doses are needed to guarantee an equally tolerated colonoscopy.

Guidelines for the management of ulcerative colitis. Recommendations of the Polish Society of Gastroenterology and the Polish National Consultant in Gastroenterology

“…Polyethylene glycol in a split (high-volume (4 l) or low-volume (2 l)) dose is the preferred agent for bowel cleansing before colonoscopy in patients with IBD [ 144 ]. Such preparation is similarly tolerated as in people without IBD [ 145 ]. Adequate bowel cleansing should be confirmed in 90% of colonoscopies [ 146 ].…”

Insights into the role of gastrointestinal ultrasound in ulcerative colitis

“…To perform GIUS, no specific preparation is required, but the patient should fast for 3 h before the examination. GIUS is performed with the patient in supine position, with standard abdominal probes (3.5-5 MHz) and high-frequency probes (7)(8)(9)(10)(11), with gradual compression. In general, a standard probe is used to get an initial panoramic view of the abdomen and bowel, while high frequency is necessary to correctly assess bowel wall thickness (BWT), stratification, ulceration, and peristalsis.…”

“… 2 However, it is an expensive, invasive diagnostic tool that is generally not well accepted by IBD patients due to the required bowel preparation before the exam and to the discomfort or pain during the procedure. 8 , 9 As a consequence, new imaging techniques have been developed. Among these, gastrointestinal ultrasound (GIUS) appears to be one of the best in terms of diagnostic yield, costs, and acceptability.…”