September 23rd, 2013
Making Bowel Preps Palatable
We know that split-dose, polyethylene glycol (PEG)–based bowel preparation solutions provide the best cleansing before colonoscopy. However, many patients are not compliant with the bowel prep procedure because of the poor taste of the PEG solution. Results of a recent trial suggest a practical approach to overcoming this problem: Use candy. In the trial, use of menthol-flavored candy while drinking the PEG solution improved tolerability and resulted in higher-quality colon preparation and a better patient experience.
In that same vein, I have noted that physicians use other methods of making the solution more palatable, including adding flavoring to the prep or masking the flavor of PEG with an additional agent during ingestion. (My personal favorite is to chase each gulp with a sip of black coffee!)
So what do you do to enhance your colonoscopy prep’s tolerability?
- Add a dilutant with flavor?
- Use an adjunctive flavor when ingesting?
- Slow delivery down further?
- Something else?
I (and a lot of fifty-plus-year-olds) look forward to you revealing your secrets!
3 Responses to “Making Bowel Preps Palatable”
M. Brian Fennerty, MD
Editor-in-Chief
NEJM Journal Watch Gastroenterology
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I’m a medical writer, not a physician, but as a G.I. patient and veteran of years of colonoscopies, I can tell you that you may be able to disguise the taste of bowel preps, but alas, you can’t avoid the inevitable side effects, whether you take it with candy, coffee or vodka. My doctor once had me mix an entire bottle of MiraLax with a quart of Gatorade (MiraLax has no flavor anyway). It tasted okay, but the bolus of ingredients usually reserved for one dose caused vomiting, so that I was unable to complete the prep (although I was about halfway through it by then). Nevertheless, it was categorized as a “fair” prep. I don’t know that it’s possible to get a thorough “cleanout” down below without getting one “up above” as well!
Drinking large amounts of Gatorade (or other sweetened liquids) as part of a bowel cleansing prep should carry the reminder that some of these products contain fructose that can cause nausea, bloating and abdominal distention – especially when consumed in high volume. This warning is most important when the study is requested for a condition likely to be associated with fructose-intolerance.
Rather than give “routine” instructions to chill liquids to improve flavor, patients should be asked, “Do you prefer to drink water iced or at room temperature?” Following their lead may benefit those who have learned that drinking cold liquids adversely affects their GI comfort – especially when they are about to consume 2-4 liters of fluid in a short period of time. (I am in that group.)
Similarly, valuable information might be gained by asking about past bowel-prep history: What types have you used? Were you able to complete the recommended regimens? If not, what made it difficult to comply? The responses might alter recommendations or instructions because a clinically-preferred prep might not be preferred when it is known that the patient will refuse or be unable to tolerate it.
Hi. I call myself the “Colonoscopy Queen”. I’m 67 and have yearly colonoscopies since age 30. (My father colon cancer at age 40.)
I recently had an emergency stay at the local hospital and after 3 days they decided a colonoscopy was in order. I had 1 hour to drink the dreaded polyeth glycol. One blessed nurse came to my rescue. She poured 4 cups of the obnoxious elixir and then added CRYSTAL LIGHT. It was amazing. I got the 4 cups down in the hour I had been allotted. I wasn’t nauseous; no headache; no nothing. God Bless the nurses. They always know the tricks. The doctors are robots and have no compassion – no matter what the ailment.
BTW, I tried all the Crystal Light flavors; all were good, but raspberry or cherry were my favorite.
FEAR NO MORE. Go buy Crystal Light. (I have no official relationship with Crystal Light, not relatives working for this company.) Bet their stock would rise if they started advertising this wonderful solution!
Sue