by wayne persky |
RSS Feed When following our gastroenterologist's prescribed cleanout procedure to prepare for a colonoscopy, many of us have discovered that it could be argued that the worst part of the procedure, is convincing ourselves to finish drinking the rest of that prep solution, after we've discovered how nauseating the first few swallows tasted, and we've managed to force about half of it down.
Many of us have nausea problems during cleanout preparation.
Apparently, about 1/3 of MC patients are plagued by nausea issues that can range from minor to debilitating, at times. So deciding whether or not to continue drinking the liquid, as the nausea increases, requires a lot of soul-searching, unless we happen to feel invincible (or foolhardy). In some cases, the nausea can be so bad that we're unable to finish, for fear of regurgitating all of it.
Is GoLytely appropriately named?
The cleanout solution known as "GoLytely", for example, requires drinking a gallon of solution — a formidable task for someone who has the digestive issues typically associated with active MC. Incidentally, whoever named that product must've been a real joker (or a cruel sadist) — there's nothing "lyte" about the process of "going", after drinking GoLytely. Cleanout solutions are typically caustic, and many are nauseating and inflammatory to our intestines.
Some cleanout products have been removed from the market.
In the past, some of the cleanout solutions that had been previously approved by the FDA, have been removed from the market, because they were so caustic that for some patients, they were causing the development of MC or other health issues where they didn't exist prior to drinking the solution. In fact, studies have been done on the association of emergency room (ER) visits following colonoscopy exams of IBD patients.
For example, one such study, of 212,205 IBD patients who had at least one colonoscopy between 2007 and 2010, showed that 3, 699 of those patients had an ER visit within 10 weeks after having a colonoscopy Burnett-Hartman, et al., 2019).1 The researchers looked at ER visits during two particular time frames — 1–4 weeks after having a colonoscopy, and 7–10 weeks after having a colonoscopy. Because visits during the first time period were likely to be associated with a colonoscopy, and visits during the second time period were more likely not to be associated with a colonoscopy, they compared the ratio of these visits.
For example, one such study, of 212,205 IBD patients who had at least one colonoscopy between 2007 and 2010, showed that 3, 699 of those patients had an ER visit within 10 weeks after having a colonoscopy Burnett-Hartman, et al., 2019).1 The researchers looked at ER visits during two particular time frames — 1–4 weeks after having a colonoscopy, and 7–10 weeks after having a colonoscopy. Because visits during the first time period were likely to be associated with a colonoscopy, and visits during the second time period were more likely not to be associated with a colonoscopy, they compared the ratio of these visits.
Prep solutions using sodium phosphate appeared to be a smoking gun.
The researchers found that in general, the relative risk (RR) of an ER visit was 1.24 during the month after a colonoscopy. And they found that the RR jumped to 2.09, for those who had used a sodium phosphate bowel preparation prior to the colonoscopy.
Products that have been removed from the market include:
Fleet Phoso-Soda and Fleet Phoso Soda EZ Prep Bowel Cleansing System. C.B. Fleet, Inc. stopped selling these products over the counter when the FDA issued a requirement for black box warnings on two similar prescription only products, Osmoprep® and Visicol® (both based on sodium phosphate). A generic version of the products sold over the counter by C.B. Fleet, Inc., is still available, in over-the-counter form.
HalfLytely (active ingredient polyethylene glycol 3350) and Bisacodyl Tablets Bowel Prep Kit has also been removed from the market. Currently, based on products that are available, it appears that the preferred cleanout solution is a mixture of MiraLAX and Gatorade.
HalfLytely (active ingredient polyethylene glycol 3350) and Bisacodyl Tablets Bowel Prep Kit has also been removed from the market. Currently, based on products that are available, it appears that the preferred cleanout solution is a mixture of MiraLAX and Gatorade.
But now, the FDA has approved Suflave.
Will it be kinder and gentler on our digestive system? A company press release claims that it will taste similar to a lemon lime sports drink, and it was scheduled to be available in August, 2023. According to an article in Gastroenterology & Endoscopy News, the ingredients appear to be somewhat familiar.2 The product will consist of a combination of an osmotic laxative utilizing 178.7 g of polyethylene glycol 3350, 7.3 g of sodium sulfate, 1.12 g of potassium chloride, 0.9 g of magnesium sulfate, 0.5 g of sodium chloride,, and lemon-lime flavoring. And it will be designed to be taken in two doses. Looking at the ingredients, it's difficult to visualize how this will be less nauseating than GoLytely (at least, for those of us who have nausea issues associated with MC), but will tell. At least, it's another new option.
Before agreeing to a repeat colonoscopy request from your gastroenterologist,
always remember that colonoscopies are not risk-free procedures, and according to published medical research, perforation rates range from 0.005–0.085% (Kim, Kim, and Park, 2019).3 This is a small percentage, and the rate seems to be holding steady over the last 15 years, but a perforation requires prompt emergency surgery, and that surgery is associated with a relatively high mortality rate, because of the rather high risk of infection.
MC can only be diagnosed by using a colonoscopy to collect biopsy samples.
A colonoscopy (or at least a sigmoidoscopy) is required in order to collect the biopsies necessary for a diagnosis of MC, but once the disease is diagnosed, it's a permanent diagnosis. Some gastroenterologists have a much worse track record of adverse events, than others, and the age, and fragility of their patients matters. When a gastroenterologist's prescribed treatment is not effective, most of them will request a repeat colonoscopy so they can search for another reason for the continued diarrhea. But another reason is almost never found, because the problem is virtually always due to the ineffectiveness of the treatment that the gastroenterologist prescribed, and not some other issue.
"New" gastroenterologists usually want to perform a colonoscopy.
If a patient changes gastroenterologists, the new gastroenterologist will often request a colonoscopy, despite the fact that a colonoscopy may have been performed within the last few months by the previous gastroenterologist. Incorrect diagnoses of MC do not exist. An MC diagnosis is virtually always 100% correct. By contrast, many cases of MC are misdiagnosed as IBS, or some other issue, but anyone who has been diagnosed with MC after biopsy samples from the lining of their colon have been examined under a microscope by a pathologist, definitely has MC. And a follow-up colonoscopy to verify that diagnosis is almost never productive.
Preparing for a colonoscopy can also be risky.
As discussed above, in addition to the risk imposed by the colonoscopy itself, some of the prep solutions used before a colonoscopy have been associated with causing MC for some patients, who didn't have MC before the prep solution was used. Most of the products that are prescribed for this procedure are very irritating (inflammatory) for the epithelial lining of the colon. Those that are not, are not as popular with gastroenterologists, because they're less effective for providing a clear view through the scope, during a colonoscopy.
References
1. Burnett-Hartman, A. N., Hua, X., Rue, T. C., Golchin, N., Kessler, L., & Rowhani-Rahbar, A. (2019). Risk interval analysis of emergency room visits following colonoscopy in patients with inflammatory bowel disease. PLoS One, 14(1), e0210262. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326490/
2. Gastroenterology & Endoscopy News Staff. (2023, June 27). FDA Approves New Drinkable Bowel Prep Option With Suflave. Gastroenterology & Endoscopy News, Retrieved from https://www.gastroendonews.com/FDA-Update-and-Product-News/Article/06-23/FDA-Approves-New-Drinkable-Bowel-Prep-Option-With-Suflave/70675?sub=&tken=28D0302C8A43FD2FA8C07583E1176C63D13D7F836F03BE9FDCFC2888550&enl=true&dgid=&utm_source=enl&utm_content=1&utm_campaign=20230629&pos=1&utm_medium=button
3. Kim, S. Y., Kim, H. S., and Park, H. J. (2019). Adverse events related to colonoscopy: Global trends and future challenges. World Journal of Gastroenterology, 25(2), 190–204. Retrieved from https://www.wjgnet.com/1007-9327/full/v25/i2/190.htm
