Abstract
Background
Patients on psychotropic medications have been clinically observed to have higher rates of abnormal colonic architecture resulting in difficult colonoscopies. This study aims to determine if a correlation between use of psychotropic medications and colonic architectural change seen on colonoscopy exists.
Methods
A retrospective case–control study was undertaken with 252 adults selected from the hospital endoscopy database between January 2006 and July 2008. Cases were selected if they had ‘capacious’, ‘megacolon’, ‘redundant’ and/or ‘featureless’ colonic architecture reported in their first completed colonoscopy (n = 63). Demographic information and medication records were collected for both cases and controls. Logistic regression analysis was performed for each of the medication groups.
Results
Medication groups associated with increased incidence for colonic architectural changes observed during colonoscopy include: antipsychotic medications [odds ratio (OR) 7.79, confidence interval (CI) 2.59–23.41], benzhexol (OR 23.50, CI 2.83–195.08) and iron tablets (OR 2.97, CI 1.39–6.33). Antidepressants, laxatives, benzodiazepines, gastroprotective medications and antihypertensive medications were not found to have any significant effect on changes to colonic architecture.
Conclusions
Use of antipsychotic medications is associated with changes to colonic architecture. This could predispose such a patient to difficult colonoscopy and therefore increase colonoscopy-associated risks. Medication history should be elicited prior to colonoscopy.
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References
Gupta M et al (2010) Constipation is not associated with an increased rate of findings on colonoscopy: results from a national endoscopy consortium. Endoscopy 42(3):208–212
Jean Marc Canard JCL, Palazzo L, Penman I, Lennon AM (2011) Gastrointestinal Endoscopy in Practice
Saunders BP et al (1995) Can barium enema indicate when colonoscopy will be difficult? Clin Radiol 50(5):318–321
Eickhoff A et al (2010) Colon anatomy based on CT colonography and fluoroscopy: impact on looping, straightening and ancillary manoeuvres in colonoscopy. Dig Liver Dis 42(4):291–296
Jung Y, Lee SH (2012) How do I overcome difficulties in insertion? Clin Endosc 45(3):278–281
Davis JM, Chen N, Glick ID (2008) Issues that may determine the outcome of antipsychotic trials: industry sponsorship and extrapyramidal side effect. Neuropsychopharmacology 33(5):971–975
Rhoades HM, Overall JE (1984) Side effect potentials of different antipsychotic and antidepressant drugs. Psychopharmacol Bull 20(1):83–88
Gatto NM et al (2003) Risk of perforation after colonoscopy and sigmoidoscopy: a population-based study. J Natl Cancer Inst 95(3):230–236
Rabeneck L et al (2008) Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology 135(6):1899–1906 1906 e1
Panteris V, Haringsma J, Kuipers EJ (2009) Colonoscopy perforation rate, mechanisms and outcome: from diagnostic to therapeutic colonoscopy. Endoscopy 41(11):941–951
Hanson ME et al (2007) Anatomic factors predictive of incomplete colonoscopy based on findings at CT colonography. AJR Am J Roentgenol 189(4):774–779
Nakamura H, Fu K, Yamamura A (2011) Magnifying gastroscopy using a soft black hood for difficult colonoscopy. Surg Endosc 25(9):3016–3021
Hardacre JM, Ponsky JL, Baker ME (2005) Colonoscopy vs CT colonography to screen for colorectal neoplasia in average-risk patients. Surg Endosc 19(3):448–456
De Hert M et al (2011) Prevalence and severity of antipsychotic related constipation in patients with schizophrenia: a retrospective descriptive study. BMC Gastroenterol 11:17
Nierenberg AA et al (2008) A brief review of antidepressant efficacy, effectiveness, indications, and usage for major depressive disorder. J Occup Environ Med 50(4):428–436
Cappell MS (2004) Colonic toxicity of administered drugs and chemicals. Am J Gastroenterol 99(6):1175–1190
Lim DK, Mahendran R (2002) Risperidone and megacolon. Singapore Med J 43(10):530–532
Marder SR, Meibach RC (1994) Risperidone in the treatment of schizophrenia. Am J Psychiatry 151(6):825–835
Cosentino M et al (1992) Motility of rabbit proximal colon. Relevance of cholinergic pathways and role of different muscarinic receptor subtypes. Dig Dis Sci 37(11):1746–1753
Fargeas MJ, Fioramonti J, Bueno L (1990) Involvement of dopamine in the central effect of neurotensin on intestinal motility in rats. Peptides 11(6):1169–1173
Oehl M, Hummer M, Fleischhacker WW (2000) Compliance with antipsychotic treatment. Acta Psychiatr Scand Suppl 407:83–86
Ilott R (2005) Does compliance therapy improve use of antipsychotic medication? Br J Community Nurs 10(11):514–519
Naber D (2008) Subjective effects of antipsychotic drugs and their relevance for compliance and remission. Epidemiol Psichiatr Soc 17(3):174–176
Acknowledgments
The authors would like to acknowledge Dr. Shen Liang (Department of Biostatistics, National University of Singapore, Singapore) for her help in the statistical analysis.
Disclosures
Authors Tan Eu Jin, Soh Keng Chuan and Ngiam Kee Yuan have no conflicts of interest or financial ties to disclose.
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Tan, E.J., Soh, K.C. & Ngiam, K.Y. Colonic architectural change on colonoscopy in patients taking psychotropic medications. Surg Endosc 27, 1601–1606 (2013). https://doi.org/10.1007/s00464-012-2636-2
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DOI: https://doi.org/10.1007/s00464-012-2636-2