Then comes the glassful unpleasant-tasting colon-cleansing liquid — glassful after glassful of it — that compels the patient to trot to the toilet. Since it's quite clear that colonoscopies save lives, colonoscopy prep is a big deal. An empty colon is necessary for the doctor to thoroughly examine the digestive tract for signs of cancer, including detecting harder-to-see flat polyps, says Dr.
However, emptying the bowel completely is not a simple matter. Electrolytes are minerals in the blood and other body fluids that carry an electric charge, and they affect the amount of water in your body, your muscle function, and other important processes. For patients with health problems, the fasting and cleansing carry special considerations. Gastroenterologists can choose among several products when they prescribe bowel preps, and different doctors apparently have their favorites.
Many FDA-approved agents are lower volume SuPrep, Prepopik, and MoviPrep , requiring the patient to drink less prep liquid, and can be the right fit for many healthy patients, he says. Not interested in gulping down questionable-tasting liquid? Another bowel preparation requires the patient to take 32 capsules, but it carries risks of kidney insufficiency and electrolyte problems and thus it is generally not used unless the patient is very healthy and specifically requests it, says Albers.
They are better suited for people who have risk factors for less-than-ideal bowel preparation, he says. These include people on narcotics and similar medications that slow down the bowel, those with prior poor preparations, and very tall or very obese patients, research has shown.
These prescription four-liter bowel preps also are generally felt to be safest for patients who have other diseases, such as diabetes or kidney, heart and liver disease because they limit fluid shifts and electrolyte disturbances.
However, the somewhat-ironically named GoLytely is not many patients' top choice. The good news is that doctors now recommend splitting the laxative dose; drinking half of the solution the day before and the other half about five hours before the colonoscopy. Search PracticeUpdate Cancel. The poorest bowel cleansing occurred in men, opioid users, tricyclic antidepressant users, people with diabetes, and people with cirrhosis.
This abstract is available on the publisher's site. Access this abstract now. Additional Info. National Library of Medicine. The products had similar adverse side effect profiles.
In addition, the palatable taste and the low volume of liquid that patients are required to consume also makes it a more patient-friendly bowel preparation than other PEG laxatives.
A major drawback of this group is the requirement to drink 4L of the solution, which might be too much for some patients.
Worthington J et al. Magnesium Citrate: Although not FDA-approved as a bowel preparation, magnesium citrate is a hyperosmotic laxative that has long been a component of bowel-cleansing regimens. In addition to drawing fluid into the colon and increasing motility, magnesium citrate also stimulates the release of cholecystokinin, leading to intestinal accumulation of fluid and electrolytes and eventual evacuation of the bowels.
Magnesium citrate typically is not used as monotherapy for bowel cleansing. It is frequently administered with bisacodyl and has been used as an adjunct to low-volume PEG for colonoscopy preparation. Patients with abdominal pain or hemorrhage or renal dysfunction should avoid its use.
Although they are considered less tolerable than NaP products, regimens containing magnesium citrate are generally well tolerated.
For this reason, along with its relative affordability, magnesium citrate may be considered an alternative for appropriate patient populations. Over the last several years, three new products have been FDA-approved for use in colonoscopy preparation.
These agents were developed to better address the challenge of improving tolerability while maintaining efficacy. Caution should be exercised in patients with a history of arrhythmias, seizures, renal impairment, significant gastrointestinal GI disease, impaired gag reflex, regurgitation or aspiration, and fluid or electrolyte imbalances. These salts draw water into the lumen of the GI tract to promote cathartic effects. On the evening before the procedure, the first oz bottle should be consumed, followed by 32 oz of water, over 1 hour.
On the morning of the procedure, at least 2 hours prior to the procedure, the regimen is repeated with the second oz bottle. Clinical trials evaluating both one-dose and split-dose regimens have demonstrated similar efficacy and safety compared with PEG preparations.
Sodium Picosulfate Preparation Prepopik : Prepopik sodium picosulfate, magnesium hydroxide, anhydrous citric acid is a oz preparation that combines a stimulant laxative with an osmotic laxative, making it the lowest-volume preparation currently available in the U.
Sodium picosulfate is a prodrug that is hydrolyzed and activated by colonic bacteria to produce peristalsis. Magnesium hydroxide and anhydrous citric acid react with water to form magnesium citrate, further promoting a laxative effect. Prepopik is contraindicated in patients with severely reduced renal function. When one-dose regimens of low-volume PEG plus bisacodyl tablets were compared with Prepopik, both preparations were equally effective for bowel cleansing.
In a comparison of split-dose regimens, Prepopik had slightly superior efficacy. Tolerability was also improved with Prepopik. Bowel preparations containing this combination have been studied and used extensively outside the U. Combination Osmotic Laxative Suclear : Suclear sodium sulfate, potassium sulfate, and magnesium sulfate; PEG, sodium chloride, sodium bicarbonate, potassium chloride , the latest bowel preparation approved by the FDA January , combines the osmotic effects of oral sulfates and PEG to induce cathartic effects in the GI tract.
Split-dose administration of Suclear is preferred. On the evening before the procedure, the 6-oz bottle of oral sulfate solution should be diluted and consumed, followed by 32 oz of water, over 2 hours.
On the morning of the procedure, the 2-L jug of PEG should be reconstituted and consumed at a rate of 16 oz every 20 minutes, to be completed 2 hours before procedure. In two different studies comparing one-dose regimens and split-dose regimens of low-volume PEG, with or without bisacodyl tablets, the proportion of successful colon cleansing was similar between groups.
Suclear may be considered an alternative bowel preparation. Before the widespread use of PEG, the enema was an important component of bowel preparation. The increased discomfort and lack of improvement in the quality of bowel cleansing have minimized the popularity of this agent. The enema appears to maintain its role as an adjunct in patients who present for colonoscopy with inadequate bowel preparation.
The need to ingest a large volume of fluid has been one of the greatest challenges in successful administration of bowel preparations. Laxatives such as senna, bisacodyl, and magnesium citrate have been used for their additive cathartic effects, reducing the volume of PEG required for cleansing. GI symptoms such as nausea, bloating, and gas also limit the tolerability of bowel preparations. These symptoms can be alleviated with use of adjunct agents.
Metoclopramide has been shown to reduce the occurrence of nausea and bloating. Simethicone can reduce bloating and gas, and it also may be used to eliminate foam formation and improve visualization for colonoscopy screenings. Information on topics such as timing, concomitant medications, diet, improving tolerability, and hydration is helpful for successful bowel preparation. For optimal colonic cleansing, at least a portion of the bowel preparation must be ingested within 6 to 8 hours of the procedure.
To ensure optimal visualization of the colon, patients must precisely follow the instructions provided by their healthcare professional HCP or the manufacturer.
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