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Risk Factors Associated with Inadequate Bowel Preparation in Patients with Functional Constipation

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Abstract

Background

Constipation is a common reason of poor bowel preparation, which negatively influences the quality of colonoscopy. Risk factors for inadequate bowel preparation in constipated patients remain unclear.

Aims

This study aimed to investigate the high-risk factors that might influence the quality of bowel preparation in patients with functional constipation.

Methods

Consecutive patients with functional constipation who underwent colonoscopy between June 2016 and April 2017 were enrolled. A standard split dose of 4 l polyethylene glycol was used for bowel preparation. Patient- and procedure-related parameters were recorded. The primary outcome was an adequate rate of bowel preparation. Risk factors for inadequate bowel preparation were screened by multivariate logistic regression analysis.

Results

A total of 199 patients were included. Adequate bowel preparation was found in 62.8% (125/199) of patients. At multivariate analysis, Bristol stool form scale (BSFS) 1 [odds ratio (OR) 2.73, 95% confidence interval (CI) 1.26–5.90; P = 0.011], rectal pain score during defecation < 2 (OR 4.14, 95% CI 1.22–13.97; P = 0.022), and starting-to-defecation interval ≥ 4 h (OR 3.83, 95% CI 1.34–10.91; P = 0.012) were risk factors for inadequate bowel preparation in patients with constipation. For patients with no, 1, 2, or 3 risk factors, the rates of inadequate bowel preparation were 11%, 23%, 49%, and 65%, respectively.

Conclusions

With the standard preparation regime, > 1/3 of patients with functional constipation had inadequate bowel cleansing. BSFS 1, rectal pain score during defecation < 2, and starting-to-defecation interval ≥ 4 h were identified as independent risk factors for inadequate bowel preparation in constipated patients.

Trial Registration

ClinicalTrials.gov number NCT02842411.

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Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Abbreviations

BP:

Bowel preparation

PEG:

Polyethylene glycol

BSFS:

Bristol stool form scale

BBPS:

Boston bowel preparation scale

PAC-SYM:

Patient assessment of constipation symptom

BMI:

Body mass index

SD:

Standard deviation

OR:

Odds ratio

CI:

Confidence interval

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Acknowledgments

This work was supported in part by the National Natural Science Foundation of China (81370585) and National Key Technology R&D Program (2015BAI13B07).

Author information

Author notes

  1. Xiaoyang Guo, Xin Shi, and Xiaoyu Kang have contributed equally to this work.

Authors and Affiliations

  1. State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 Changle West Road, Xi’an, 710032, Shaanxi, China

    Xiaoyang Guo, Xin Shi, Xiaoyu Kang, Hui Luo, Xiangping Wang, Hui Jia, Qin Tao, Yanglin Pan, Xuegang Guo & Daiming Fan

  2. Department of Ultrasound, The 305 Hospital of PLA, Beijing, China

    Xiaoyang Guo

  3. Department of Gastroenterology, Tangdu Hospital, Fourth Military Medical University, Xi’an, China

    Xiaoyu Kang & Jingjie Wang

  4. Department of Gastroenterology, The First Affiliated Hospital of Xi’an Medical University, Xi’an, China

    Mingxin Zhang

  5. Department of Gastroenterology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Jinhai Wang, Xiaolan Lu & Shiyang Ma

  6. Department of Gastroenterology, The 451 Hospital of PLA, Xi’an, China

    Tao Lin & Yujie Jing

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  1. Xiaoyang Guo
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Contributions

Author’s contribution

Study concept and design: YP, XG; acquisition of data: XG, HL, XW; MZ, SM, YJ, QT; analysis and interpretation of data: XG; drafting and editing of the manuscript: XS, YP; critical revision of the manuscript for important intellectual content: XG; statistical analysis: XG, XS, XK; administrative and material support: DF.

Corresponding author

Correspondence to Yanglin Pan.

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The authors declare that they have no competing interests.

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The study protocol and informed consent form were approved by the ethics committees of all participating institutions. Written informed consent was obtained from all the patients.

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Guo, X., Shi, X., Kang, X. et al. Risk Factors Associated with Inadequate Bowel Preparation in Patients with Functional Constipation. Dig Dis Sci 65, 1082–1091 (2020). https://doi.org/10.1007/s10620-019-05847-5

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