January 28th, 2014
What Bowel Prep for the Sensitive Stomach?
Although it is clear that split-dose polyethylene glycol (PEG), our first-line bowel prep, provides the optimal bowel cleansing for colonoscopy, many of my patients find it difficult or even impossible to tolerate this solution (i.e., due to vomiting). Although alternatives such as Gatorade/Miralax, with or without magnesium citrate and Dulcolax, are used by many endoscopy units, these also do not work for some of my patients.
So, what approach are you taking to bowel prep for your patients with sensitive stomachs?
Specifically…
- What do you use for bowel prep in patients intolerant of standard PEG-based preps?
- What is your success rate in avoiding vomiting during this alternative prep?
- Do you ever prophylactically treat with anti-emetics before starting a prep?
4 Responses to “What Bowel Prep for the Sensitive Stomach?”
M. Brian Fennerty, MD
Editor-in-Chief
NEJM Journal Watch Gastroenterology
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I give ALL my patients a low residue diet for breakfast, lunch and dinner the day before, based on a 2010 study in Endoscopy, published by Soweid et al. This helps reduce n/v and crumming stomach from being on clears only the day before. Then I prefer a 2L split prep, 1 L and 1 L. It’s not so bad. Pts LOVE eating the day before, and my preps have never been better!
I would check for infectious gastritis beforehand with H. pylori antibody (IgG) and, if a significant titer, treat the infection. There are too many false negative exams with the gastric biopsy from PPI use. The H. pylori stool and breath tests are too expensive and may miss some who are IgG+. Or just treat empirically with a four drug protocol.
Osmo prep tablets in the split-dose manner has proven to be an excellent bowel cleansing agent for those who are liquid averse. All of the liquid preps, no matter how “seasoned” taste to a greater or lesser degree like motor oil.
I generally use split dosing PEG with prokinetics or use another solution with less volume (phosphosoda ou manitol). In specific cases I would suggest in hospital preparation.