Simpler Bowel Prep May Help IBD Patients Get Needed Colonoscopies

Colonoscopies are a crucial diagnostic and monitoring tool for patients with inflammatory bowel disease (IBD). However, having one can be intimidating when faced with the daunting bowel preparation that it requires. The solution most people drink beginning the day before the test to help cleanse the bowel doesn’t taste great and can come in large quantities, making it hard to consume the entire prep. And once it goes in—well, let’s just say it’s not long before there’s a whole lot coming out. People often spend hours rushing to the bathroom before the procedure itself. 

 

This burdensome aspect of colonoscopy prep causes a lot of people who should have colonoscopies, including many with IBD, to put off or avoid the test. 

 

Evidence that some oral bowel preparations, especially those containing sodium phosphate, may injure the lining of the colon to the point that the injury mimics Crohn’s disease, may make some people with IBD reluctant to have the test, as well. 

 

However, a recent study of IBD patients published in Crohn’s & Colitis 360 looked at the feasibility and efficacy of an alternative to traditional bowel prep. It found that HygiPrep, a newer type of colonoscopy preparation, is safe, effective, and well-tolerated by people with Crohn’s and ulcerative colitis (UC). What’s more, patients preferred it to more traditional bowel prep methods. 

 

HygiPrep: Same-day colon preparation


HygiPrep uses gravity-fed water infusions to flush out the contents of your colon immediately before your colonoscopy. 


The prep takes place while you’re seated on a comfortable, sanitized basin. First, a trained nurse or technician inserts a sterile nozzle about an inch into your rectum. Then, they release a gentle stream of warm water. The water loosens any stool and continues to flow until your bowels are clean and fully prepared.


This takes only about an hour to complete.  Dietary modifications remain the same as the day before your colonoscopy with traditional oral bowel prep. Also, doctors may recommend a pill stimulant laxative to be taken the day before and morning of the HygiPrep. 

 

What the study found


To evaluate HygiPrep with IBD patients, researchers looked at 318 people with Crohn’s or UC who were 20 to 85 years old. About three-quarters of them were women. Fifty-eight percent had UC, while 33% had Crohn’s. About 3% had both conditions  listed on orders, and 6% had unspecified IBD. In total, the participants underwent 342 HygiPrep procedures between September 2016 and March 2021.

 
By studying these individuals and their experiences, researchers found that: 
• 97% of participants were adequately prepared for their colonoscopy. In most cases, even people with conditions that are often predictors of poor bowel prep, such as diabetes, constipation, or severe hemorrhoids, had adequacy rates near or beyond 90%.
• On a scale of 0 to 3, the average participant preference for the newer colon cleansing method over traditional preparation was 2.73.
• Participants showed very high satisfaction with HygiPrep, as demonstrated by open-ended text responses. 
• Patients had no serious adverse events related to their prep. Notably, the more traditional prep-associated issues such as nausea, vomiting, diarrhea, and abdominal pain or cramping were each reported by less than 10% of participants.

 

Why this study is important 
 

IBD patients have an increased risk for colorectal cancer. So doctors advise IBD patients who have had symptoms for eight years or more to get a colonoscopy every one to two years. Not everyone follows these guidelines. Reducing the barriers to colonoscopy by making bowel preparation more tolerable may lead more people to adhere to their doctor’s recommendations. Ultimately, this could help patients better manage their IBD and find instances of colorectal cancer in their earliest stages when cancer tends to be most treatable. 


HygiPrep allows doctors to study IBD patients’ colons without introducing the chemical agents used in many traditional bowel preps. As a result, patients may avoid injury to their colon lining that’s possible with other prep methods and can make colon assessment more difficult. The chemical-free approach could also open the door to more accurate detection of biomarkers (indicators of disease) and microbiome research that could lead to personalized medicine.


This study is an example of the valuable information people living with IBD can help bring to light by participating in clinical trials. For more information about clinical trials, please visit the Crohn’s & Colitis Foundation’s Clinical Trials Community.