Comparison of efficacy and safety of polyethylene glycol and sodium phosphate in colon preparation of patients with constipation

Yıl 2009, Cilt: 17 Sayı: 1, 23 - 27, 01.04.2009

Yekta Tüzün Coşkun Beyaz Mustafa Yakut Şerif Yılmaz Kadim Bayan Mehmet Dursun Fikri Canoruç

Öz

Background and Aims: Polyethylene glycol and oral sodium phosphate solutions are widely used agents in colon cleansing. Although there are studies in the literature comparing the efficacy of these agents, this issue has not been evaluated sufficiently in patients with constipation. Our aim was to compare the efficacy and tolerability of polyethylene glycol and oral sodium phosphate in patients with constipation. Materials and Methods: Fifty-seven patients with functional constipation and constipation-dominant irritable bowel syndrome were included. Of these, 28 were in the polyethylene glycol group and 29 were in the sodium phosphate group. A questionnaire including demographic features and problems encountered during the bowel preparation was applied. In addition, the quality of the colonic preparation was scored. Data were compared between groups. Results: Abdominal pain and nausea (p=0.04 and 0.012, respectively) in the sodium phosphate group and abdominal bloating (p=0.03) in the polyethylene glycol group were more common than in the other group, respectively. Although there was no statistically significant difference between groups with respect to the rate of clean colon (p=0.180), the rate of perfect cleansing was higher in the polyethylene glycol group (71.5% vs 55.2%). Conclusions: Polyethylene glycol and sodium phosphate demonstrated a similar efficiency and side effect profile in patients with constipation. Abdominal bloating in the polyethylene glycol group and nausea and abdominal pain in the sodium phosphate group were the dominant side effects. Further studies with wider study populations are needed to reach a more definitive conclusion.

Anahtar Kelimeler

Colon preparation, PEG, sodium phosphate, constipation

Konstipasyonlu bireylerin kolonoskopi hazırlığında polietilen glikol ile sodyum fosfatın etkinlik ve güvenilirliklerinin karşılaştırılması

Öz

Amaç: Polietilen glikol ve oral sodyum fosfat solüsyonları kolonoskopi öncesi barsak temizliği için yaygın kullanılan ajanlardır. Literatürde iki ajanın etkinliğinin karşılaştırıldığı çalışmalar olmasına karşın, bu konu özel bir grup olan konstipasyonlu hastalarda yeterince araştırılmamıştır. Amacımız konstipasyonlu hastalarda polietilen glikol ve oral sodyum fosfat solüsyonlarının etkinlik ve tolarabilite bakımından karşılaştırılmasıdır. Gereç ve Yöntem: Çalışmaya fonksiyonel kabızlık ve kabızlık egemen irritabl barsak sendromlu 57 hasta dâhil edildi. Bunların 28'i polietilen glikol, 29'u sodyum fosfat grubunda yer aldı. Hastalara demografik özellikleri ve kolon hazırlık aşamasında karşılaşılan sorunları içeren bir anket yapıldı. Ayrıca, kolonoskopi işleminde kolonun temizlik ölçüsü skorlandı. Veriler iki grupta karşılaştırıldı. Bulgular: Sodyum fosfat grubunda karın ağrısı ve bulantı daha sık gözlenirken (p=0.04 and 0.012, sırasıyla), polietilen glikol grubunda karında şişkinlik hissi daha sık saptandı (p=0.03). Kolonun temiz görülme oranı her iki grupta istatistiksel anlamlı fark gözetmemesine rağmen, (p=0.180), polietilen glikol grubunda mükemmel hazırlık oranı daha yüksekti (%71.5'a karşı %55.2). Sonuç: Konstipasyonlu hastalarda polietilen glikol ve sodyum fosfat benzer etkinlik ve yan etki profili sergilemektedir. Yan etki bakımından polietilen glikol'de şişkinlik, sodyum fosfat'ta bulantı ve karın ağrısı dominant yansımalardır. Daha güçlü bir sonuca ulaşabilmek için daha geniş serili çalışmalara gereksinim vardır.

Anahtar Kelimeler

Kolon hazırlığı, PEG, sodyum fosfat, konstipasyon

Kaynakça

• Steven DW, David EB, Todd HB, et al A consensus document on bowel pre- paration before colonoscopy: prepared by a task force from the American Society of Colon and Rectal Surgeons (ASCRS), the American Society for Gastrointestinal Endoscopy (ASGE), and the Society of American Gastroin- testinal and Endoscopic Surgeons (SAGES). Surg Endosc 2006;20:1147-60.
• Di Palma JA, Brady CE. Colon cleansing for diagnostic and surgical pro- cedures: polyethylene glycol-electrolyte lavage solution. Am J Gastroen- terol 1989;84:1008-16.
• Tooson JD, Gates LK Jr. Bowel preparation before colonoscopy. Choosing the best lavage regimen. Postgrad Med 1996;100:203-4, 207-12, 214.
• Rex DK, Imperiale TF, Latinovich DR, Bratcher LL. Impact of bowel pre- paration on efficiency and cost of colonoscopy. Am J Gastroenterol 2002;97:1696-700.
• Ness RM, Manam R, Hoen H, Chalasani N. Predictors of inadequate pre- paration for colonoscopy. Am J Gastroenterol 2001;96:1792-802.
• Drossman DA. The functional gastrointestinal disorders and the Rome III process. Gastroenterology 2006:130:1337-90.
• Heaton KW, Thompson WG. Diagnosis. In: Heaton KW, Thompson WG, eds. Irritable bowel syndrome. Oxford, Health press, 1999:21-7.
• Parra-Blanco A, Nicolas-Perez D, Gimeno-Garcia A, et al. The timing of bowel preparation before colonoscopy determines the quality of clean- sing, and is a significant factor contributing to the detection of flat lesi- ons: a randomized study. World J Gastroenterol 2006;12:6161-6.
• DiPalma JA, Marshall JB. Comparison of a new sulfate-free polyethylene glycol electrolyte lavage solution versus a standard solution for colonos- copy cleansing. Gastrointest Endosc 1990;36:285-9.
• Hookey LC, Depew WT, Vanner S. The safety profile of oral sodium phosphate for colonic cleansing before colonoscopy in adults. Gastroin- test Endosc 2002;56:895-902.
• Afridi SA, Barthel JS, King PD, et al. Prospective, randomized trial com- paring a new sodium phosphate-bisacodyl regimen with conventional PEG-ES lavage for outpatient colonoscopy preparation. Gastrointest En- dosc 1995;41:485-9.
• Henderson JM, Barnett JL, Turgeon DK, et al. Single-day, divided-dose oral sodium phosphate laxative versus intestinal lavage as preparation for colonoscopy: efficacy and patient tolerance. Gastrointest Endosc 1995;42:238-43.
• Johanson JF, Sonnenberg A, Koch TR, McCarty DJ. Association of cons- tipation with neurologic diseases. Dig Dis Sci 1992;37;179-86.
• Bergin AJ, Read NW. The effect of preliminary bowel preparation on a simple test of colonic transit in constipated subjects. Int J Colorect Dis 1993;8:75-7.
• Hsu CW, Imperiale TF. Meta-analysis and cost comparison of polyeth- ylene glycol lavage versus sodium phosphate for colonoscopy preparati- on. Gastrointest Endosc 1998;48:276-82.
• DiPalma JA, Brady CE. Pierson WP. A rapid colonic lavage solution (Golytely) vs standard preparation for barium enema and colonoscopy. Gastrointest Radiol 1986;11:375-6.
• Adams WJ, Meagher AP, Lubowski DZ, King DW. Bisacodyl reduces the volume of PEG solution required for bowel preparation. Dis Colon Rec- tum 1994;27:229-33.
• Sharma VK, Steinberg EN, Vasudeva R, Howden CW. Randomized, con- trolled study of pretreatment with magnesium citrate on the quality of colonoscopy preparation with polietylen glycol electrolyte lavage soluti- on. Gastrointest Endosc 1997;46:541-3.
• Marschall HU, Bartels F. Life-threateining complications of nasogastric administiration of polietilen glycol-electrolyte solutions (Golytely) for bowel cleansing. Gastrointest Endosc 1998;47: 408-10.
• Lever EL, Walter MH, Condon SC. Addition of enemas to oral lavaj prepa- ration for colonoscopy is not necessary. Gastrintest Endosc 1992;38:369-72.
• Markowitz GS, Stokes MB, Radhakrishnan J, D'Agati VD. Acute phosphate nephropathy following oral sodium phosphate bowel purgative: an underre- cognized cause of chronic renal failure. J Am Soc Nephrol 2005;16:3389-96.
• Holte K, Neilsen KG, Madsen JL, Kehlet H. Physiologic effects of bowel preparation Dis Colon Rectum 2004;48:393-6.
• Rejchrt S, Bures J, Siroky M, et al. A prospective, observational study of colonic mucosal abnormalities associated with orally administered sodi- um phosphate for colon cleansing before colonoscopy. Gastrointest En- dosc 2004;59:651-4.
• Cohen SM, Wexner SD, Binderow SR, et al. Prospective, randomized, endoscopic-blinded trial comparing precolonoscopy bowel cleansing methods. Dis Colon Rectum 1994;37:689-96.
• Ell C, Fischbach W, Keller R, et al. A randomized, blinded, prospective trial to compare the safety and efficacy of three bowel-cleansing soluti- ons for colonoscopy (HSG-01). Endoscopy 2003;35:300-4.
• Poon CM, Lee DW, Mak SK, et al. Two liters of polyethylene glycol-electroly- te solution versus sodium phosphate as bowel cleansing regimen for colonos- copy: a prospective randomized controlled trial. Endoscopy 2002;34:560-3.