Colon cleansing regimens in inflammatory bowel disease: a review
PEG-based preparations appear safe in IBD patients, with equivalent efficacy when comparing PEG low-volume vs PEG high-volume in split and non-split regimens.
A polyethylene glycol (PEG) low-volume regimen is noninferior to a PEG high-volume regimen for colon cleansing in patients with inflammatory bowel disease (IBD), according to data published in the World Journal of Gastroenterology.
Sophie Restellini, MD, Division of Gastroenterology, Department of Medicine, McGill University Health Center in Montreal, Quebec, and colleagues conducted a meta-analysis of 4 trials that assessed bowel cleansing preparation with or without adjuvants, given in split and non-split dosing, and in high-volume (>3 L) or low-volume (<2 L) regimens.
One trial assessed the impact of adding simethicone to PEG 4 L, and results showed no effect on bowel cleansing quality. Another trial compared the efficacy of 75 mg of senna to castor oil and found no difference between the two preparations.
Two additional trials compared the efficacy of PEG high-volume and PEG low-volume with an adjuvant, both mainly in split regimens. The first assessed the efficacy of a low-dose iso-osmotic preparation based on low-dose PEG associated to bisacodyl compared with a PEG high-volume preparation alone. The researchers found that the quality of colon cleansing was similar between the 2 groups (83% vs 75%, respectively). The second study compared the efficacy of PEG 4 L with PEG 2 L plus ascorbic acid in patients with inactive ulcerative colitis. Successful cleansing was achieved in most patients from both groups (96.2% vs 92.9%, respectively).
The investigators compared PEG high-volume with PEG low-volume with adjuvant in split dose regimens and found that there was no clinically relevant difference in bowel preparation irrespective of the type of adjuvant used (odds ratio, 0.84).
“The main results suggest that PEG-based preparations appear safe in IBD patients, with equivalent efficacy when comparing PEG low-volume vs PEG high-volume in split and non-split regimens, yielding improved tolerance for the former,” the authors of the study concluded. “Adjuvant therapies (osmotic and stimulant laxatives) were systematically associated to low-volume preparation without safety concerns. Severe side effects such as flare of the disease or preparation-induced ulcerations occurred in less than 6%.”
Restellini S, Kherad O, Bessissow T, et al. Systematic review and meta-analysis of colon cleansing preparations in patients with inflammatory bowel disease. World J Gastroenterol. 2017;23(32):5994-6002. doi:10.3748/wjg.v23.i32.5994