Skip to main content

Advertisement

SpringerLink
Log in

Importance of Bowel Habits in Predicting Inadequate Bowel Preparation: A Prospective Observational Study

  • Original Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

An Invited Commentary to this article was published on 15 September 2023

Abstract

Objectives

Inadequate bowel preparation (BP) negatively affects the efficacy and quality of colonoscopy. Although constipation has already been reported as one of the most important predictors of inadequate BP, there is limited information on the relation between inadequate BP and bowel habits including constipation-related symptoms, medications, and severity of constipation.

Methods

This single-center, prospective observational study was conducted between August 2019 and May 2020. All participants answered questionnaires regarding personal bowel habits and received low-volume polyethylene glycol plus ascorbic acid for outpatient colonoscopy. Severity of constipation was evaluated by constipation scoring system. Bowel preparation cleansing was evaluated using Boston Bowel Preparation Scale (BBPS). Potential predictors of inadequate BP were analyzed using multivariate logistic regression models.

Results

Overall, 1054 patients were enrolled, of which, 105 (10%) had inadequate BP (total BBPS ≤ 6 or any segmental BBPS < 2). The risk of inadequate BP increased with constipation severity (P = 0.01). Multivariate analysis showed that frequent straining (> 25% of defecations) (OR 2.09, 95% CI: 1.33–3.28) and chronic use of stimulant laxatives (OR 2.57, 95% CI: 1.59–4.17) were significant predictors of inadequate BP, among personal bowel habits.

Conclusion

Frequent straining and chronic use of stimulant laxatives were predictors of inadequate BP. An intensified preparation regimen should be considered for severely constipated patients with straining and chronic use of stimulant laxatives.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Rex DK, Imperiale TF, Latinovich DR et al. Impact of bowel preparation on efficiency and cost of colonoscopy. Am J Gastroenterol 2002;97:1696–1700.

    Article  PubMed  Google Scholar 

  2. Burke CA, Church JM. Enhancing the quality of colonoscopy: the importance of bowel purgatives. Gastrointest Endosc 2007;66:565–573.

    Article  PubMed  Google Scholar 

  3. Hassan C, East J, Radaelli F et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline—update 2019. Endoscopy 2019;51:775–794.

    Article  PubMed  Google Scholar 

  4. Serper M, Gawron AJ, Smith SG et al. Patient factors that affect quality of colonoscopy preparation. Clin Gastroenterol Hepatol 2014;12:451–457.

    Article  PubMed  Google Scholar 

  5. Lorenzo F, Leonardo F, Cristiano S et al. Factors that affect adequacy of colon cleansing for colonoscopy in hospitalized patients. Clin Gastroenterol Hepatol 2021;19:339–348.

    Article  Google Scholar 

  6. Mahmood S, Farooqui SM, Madhoun MF. Predictors of inadequate bowel preparation for colonoscopy: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2018;30:819–826.

    Article  PubMed  Google Scholar 

  7. Yee R, Manoharan S, Hall C, Hayashi A. Optimizing bowel preparation for colonoscopy: what are the predictors of an inadequate preparation? Am J Surg 2015;209:787–792.

    Article  PubMed  Google Scholar 

  8. Gandhi K, Tofani C, Sokach C et al. Patient characteristics associated with quality of colonoscopy preparation: A systematic review and meta-analysis. Clin Gastroenterol Hepatol 2018;16:357–369.

    Article  PubMed  Google Scholar 

  9. Bharucha AE, Lacy BE. Mechanisms, evaluation, and management of chronic constipation. Gastroenterology 2020;158:1232-1249.e3.

    Article  CAS  PubMed  Google Scholar 

  10. Bharucha AE, Pemberton JH, Locke GR et al. American Gastroenterological Association technical review on constipation. Gastroenterology 2013;144:218–38.

    Article  PubMed  Google Scholar 

  11. Imran A, William EW, Olafur SP et al. An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation. Expert Rev Gastroenterol Hepatol 2020;14:39–46.

    Article  CAS  Google Scholar 

  12. Drossman DA, Hasler WL. Rome IV-functional GI disorders: disorders of gut-brain interaction. Gastroenterology. 2016;150:1257–1261.

    Article  PubMed  Google Scholar 

  13. Malhotra A, Shah N, Depasquale J et al. Use of Bristol Stool Form Scale to predict the adequacy of bowel preparation: a prospective study. Colorectal Dis 2016;18:200–204.

    Article  CAS  PubMed  Google Scholar 

  14. Lee DW, Koo JS, Kang S et al. Association between bowel habits and quality of bowel preparation for colonoscopy. Medicine (Baltimore) 2017;96:e7319.

    Article  PubMed  Google Scholar 

  15. Paik N, Kim ER, Kim TJ, Hong SN, Chang DK, Kim YH. Usefulness of personal bowel habits as a predictive factor for inadequate bowel preparation for colonoscopy: a prospective questionnaire-based observational study. Gut Liver 2019;13:169–175.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Maeda N, Higashimori A, Nakatani M et al. Efficacy and tolerability of 1 L polyethylene glycol plus ascorbic acid with senna versus 2 L polyethylene glycol plus ascorbic acid for colonoscopic bowel preparation: prospective, randomized, investigator-blinded trial. Dig Endosc. 2022. https://doi.org/10.1111/den.14504.

    Article  PubMed  Google Scholar 

  17. Lai EJ, Calderwood AH, Doros G et al. The Boston bowel preparation scale: a valid and reliable instrument for colonoscopy-oriented research. Gastrointest Endosc 2009;69:620–625.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kang X, Zhao L, Zhu Z et al. Same-day single dose of 2 liter polyethylene glycol is not inferior to the standard bowel preparation regimen in low-risk patients: a randomized, controlled trial. Am J Gastroenterol 2018;113:601–610.

    Article  CAS  PubMed  Google Scholar 

  19. Agachan F, Chen T, Pfeifer J, Reissman P et al. A constipation scoring system to simplify evaluation and management of constipated patients. Dis Colon Rectum 1996;39:681–685.

    Article  CAS  PubMed  Google Scholar 

  20. Higashimori A, Nakatani M, Jinnai K et al. Chronic constipation is negatively associated with colonic diverticula. Scand J Gastroenterol 2021;56:1264–1270.

    Article  CAS  PubMed  Google Scholar 

  21. Oktora MP, Alfian SD, Bos HJ et al. Trends in polypharmacy and potentially inappropriate medication (PIM) in older and middle-aged people treated for diabetes. Br J Clin Pharmacol 2021;87:2807–2817.

    Article  CAS  PubMed  Google Scholar 

  22. Wynants L, Bouwmeester W, Moons KG et al. A simulation study of sample size demonstrated the importance of the number of events per variable to develop prediction models in clustered data. Journal of clinical epidemiology. 2015;68:1406–1414.

    Article  CAS  PubMed  Google Scholar 

  23. Peduzzi P, Concato J, Kemper E et al. A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol. 1996;49:1373–1379.

    Article  CAS  PubMed  Google Scholar 

  24. Rao SS, Bharucha AE, Chiarioni G et al. Functional anorectal disorders. Gastroenterology. 2016. https://doi.org/10.1053/j.gastro.2016.02.009.

    Article  PubMed  Google Scholar 

  25. Aziz I, Whitehead WE, Palsson OS et al. An approach to the diagnosis and management of Rome IV functional disorders of chronic constipation. Expert Rev Gastroenterol Hepatol 2020;14:39–46.

    Article  PubMed  Google Scholar 

  26. Wald A. Is chronic use of Stimulant Laxatives harmful to the colon? J Clin Gastroenterol 2003;36:386–389.

    Article  PubMed  Google Scholar 

  27. Noergaard M, Traerup Andersen J, Jimenez-Solem E et al. Long term treatment with stimulant laxatives—clinical evidence for effectiveness and safety? Scand J Gastroenterol 2019;54:27–34.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank our medical staff, who helped with data collection.

Funding

This research received no specific grants from any funding agency in the public, commercial, or not-for-profit sectors. Yasuhiro Fujiwara received lecture fees and research grants from EA Pharma Co. Ltd.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan

    Akira Higashimori, Natsumi Maeda, Masami Nakatani, Ikki Yamamoto, Takeshi Yanagida, Daiyu Kin, Yuji Matsumoto, Kenichi Morimoto, Eiji Sasaki, Takashi Fukuda & Tetsuo Arakawa

  2. Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan

    Akira Higashimori, Natsumi Maeda & Yasuhiro Fujiwara

Authors
  1. Akira Higashimori
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Natsumi Maeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masami Nakatani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ikki Yamamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takeshi Yanagida
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daiyu Kin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yuji Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kenichi Morimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Eiji Sasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Takashi Fukuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Tetsuo Arakawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Yasuhiro Fujiwara
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception and design: AH, NM, MNa, and TF. Analysis and interpretation of the data: AH, NM, MN, IY, TY, DK, YM, KM, and ES. Writing, review, and/or revision of the manuscript: AH and NM. Study supervision: MN, TF, TA, and YF. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Akira Higashimori.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

An editorial commenting on this article is available at https://doi.org/10.1007/s10620-023-08090-1.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 13 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Higashimori, A., Maeda, N., Nakatani, M. et al. Importance of Bowel Habits in Predicting Inadequate Bowel Preparation: A Prospective Observational Study. Dig Dis Sci 68, 4148–4155 (2023). https://doi.org/10.1007/s10620-023-08089-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-023-08089-8

Keywords

Search

Navigation