Emerging space for non-polyethene-glycol bowel preparations in inflammatory bowel disease-related colonoscopy: Veering toward better adherence and palatability

Abstract

Patients with inflammatory bowel diseases (IBDs) require repeated endoscopic evaluations over time by colonoscopy to weigh disease activity but also for different and additional indications (e.g., evaluation of postoperative recurrence, colorectal cancer surveillance). Colonoscopy, however, requires adequate bowel preparation to be of quality. The latter is achieved as long as the patient takes a certain amount of product to have a number of bowel movements suitable to clean the colon and allow optimal visualization of the mucosa during endoscopy. However, significant guidelines recommend preparations for patients with IBD not excelling in palatability. This recommendation originates from the fact that most of the studies conducted on bowel preparations in patients with IBD have been done with isosmolar preparations based on polyethylene glycol (PEG), for which, therefore, more safety data exist. As a result, the low-volume non-PEG preparations (e.g., magnesium citrate plus picosulphate, oral sulphate solutions) have been set aside for the whole range of warnings to be heeded because of their hyperosmolarity. New studies, however, are emerging, leaning in overall for a paradigm shift in this matter. Indeed, such non-PEG preparations seem to show a particularly encouraging and engaging safety profile when considering their broad potential for tolerability and patient preference. Indeed, such evidence is insufficient to indicate such preparations in all patients with IBD but may pave the way for those with remission or well-controlled disease. This article summarizes the central studies conducted in IBD settings using non-PEG preparations by discussing their results.

Keywords: Inflammatory bowel disease; Crohn’s disease; Ulcerative colitis; Bowel preparation; Colonoscopy; Polyethylene glycol; Low-volume

Core Tip: Preparations based on polyethylene glycol (PEG) are most recommended for patients with inflammatory bowel disease (IBD) undergoing colonoscopy. However, these solutions are not always palatable because they often require the intake of large volumes of solution, making it difficult for the patient to complete the entire preparation. This leads to a reduction in the quality of the endoscopic examination. Low-volume non-PEG-based, although excluded in the major guidelines for patients with IBD, are emerging as potentially safe in this setting, especially in remission or mild disease conditions.