RESUMO
AIM: The aim of this review is to provide an overview of the clinical assessment and evidence-based treatment options for managing diabetes-associated chronic constipation. METHODS: A literature search of published medical reports in English language was performed using the OVID Portal, from PUBMED and the Cochrane Database of Systematic Reviews, from inception to October 2015. A total of 145 abstracts were identified; duplicate publications were removed and 95 relevant full-text articles were retrieved for potential inclusion. RESULTS: Chronic constipation is one of the most common gastrointestinal symptoms in patients with diabetes, and occurs more frequently than in healthy individuals. Treatment goals include improving symptoms and restoring bowel function by accelerating colonic transit and facilitating defecation. Based on guidelines and data from published literature, food and dietary change with exercise and lifestyle change should be the first step in management. For patients recalcitrant to these changes, laxatives should be the next step of treatment. Treatment should begin with bulking agents such as psyllium, bran or methylcellulose followed by osmotic laxatives if response is poor. Lactulose, polyethylene glycol and lactitol are the most frequently prescribed osmotic agents. Lactulose has a prebiotic effect and a carry-over effect (continued laxative effect for at least 6 to 7 days, post cessation of treatment). Stimulants such as bisacodyl, sodium picosulphate and senna are indicated if osmotic laxatives are not effective. Newer agents such as chloride-channel activators and 5-HT4 agonist can be considered for severe or resistant cases. CONCLUSION: The primary aim of intervention in diabetic patients with chronic constipation is to better manage the diabetes along with management of constipation. The physician should explain the rationale for prescribing laxatives and educate patients about the potential drawbacks of long-term use of laxatives. They should contact their physician if short-term use of prescribed laxative fails to provide relief.
Assuntos
Constipação Intestinal/etiologia , Constipação Intestinal/terapia , Complicações do Diabetes/complicações , Bisacodil/administração & dosagem , Agonistas dos Canais de Cloreto/administração & dosagem , Doença Crônica , Citratos/administração & dosagem , Fibras na Dieta/administração & dosagem , Medicina Baseada em Evidências , Terapia por Exercício , Estilo de Vida Saudável , Humanos , Laxantes/administração & dosagem , Metilcelulose/administração & dosagem , Compostos Organometálicos/administração & dosagem , Picolinas/administração & dosagem , Psyllium/administração & dosagem , Extrato de Senna/administração & dosagem , Agonistas do Receptor 5-HT4 de Serotonina/administração & dosagemRESUMO
Background - Colonoscopy is an important diagnostic and therapeutic procedure. Adequate bowel preparation is mandatory. Several regimens were discussed in the literature. Among the drugs which has recently used, polyethylene glycol is one of the most popular agents. Objectives - The aim of this study was to compare efficacy of three different methods for 1 day preparation before colonoscopy. Methods - This study included children with the range of ages (2-21) who had an indication of colonoscopy. Exclusion criteria were based on the history of previous surgery, parental disagreement, and patients who did not use preparation protocol. Three methods for bowel preparation were studied: 1- Polyethylene glycol only; 2- Polyethylene glycol and bisacodyl suppositories; 3- Polyethylene glycol plus normal saline enema. Boston Bowel Preparation Score was used for evaluation of preparation. SPSS version 16.0 (Chicago, IL, USA) were used for data analysis. Results - In this study 83 cases completed the bowel preparation completely. Acceptable bowel preparation was seen in 24 (85.71%), 36 (94.73%), and 14 (82.35%) of cases in PEG, PEG + bisacodyl, and PEG + normal saline enema groups respectively. PEG + bisacodyl suppositories was more effective than PEG + normal saline for the preparation of the first segment ( P=0.05). For second and third segment of colon, BPPS score was higher in PEG + bisacodyl suppositories compared to other regimens, but this difference was not statistically significant. Conclusion - There was no significant difference between 1 day colonoscopy regimens in terms of bowel preparation score. Lowest score was seen in PEG + enema group compared to other group.
Contexto - A colonoscopia é um procedimento diagnóstico e terapêutico importante. A preparação intestinal adequada é obrigatória. Vários esquemas são discutidos na literatura. Dentre as drogas que se têm usado recentemente, o polietilenoglicol é um dos agentes mais utilizados. Objetivo - O objetivo deste estudo foi comparar a eficácia de três métodos diferentes para a preparação feita 1 dia antes de colonoscopia. Métodos - Este estudo incluiu crianças com a gama de idades entre 2 e 21 anos, que tinham indicação de colonoscopia. Os critérios de exclusão foram baseados em história da cirurgia anterior, não aprovação dos pais e pacientes que não utilizaram o protocolo de preparação. Três métodos para a preparação do intestino foram estudados: 1-polietilenoglicol; 2 - polietilenoglicol e bisacodil supositórios; 3 - polietilenoglicol e enema de solução salina. O escore de Boston para preparação intestinal foi usado para a avaliação e os dados foram analisados pelo SPSS versão 16.0 (Chicago, Il, USA). Resultados - Um total de 83 pacientes concluiu completamente o preparo intestinal. Houve preparo aceitável em 24 (85,71%), 36 (94,73%) e 14 (82,35%) dos casos, nos grupos PEG, PEG + bisacodil e PEG + enema salino, respectivamente. PEG + bisacodil supositórios foi mais eficaz do que a PEG + solução salina para a preparação do primeiro segmento ( P=0,05). Para segundo e terceiro segmento do cólon, a pontuação de BPPS foi maior no grupo PEG + bisacodil supositórios em comparação com outros regimes, mas essa diferença não foi estatisticamente significativa. Conclusão - Não houve nenhuma diferença significativa entre os regimes de preparo para colonoscopia de um dia em termos de pontuação de preparação do intestino. A nota mais baixa foi vista no grupo PEG + enema em comparação com outros grupos.
Assuntos
Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Adulto Jovem , Bisacodil/administração & dosagem , Catárticos/administração & dosagem , Colonoscopia/métodos , Polietilenoglicóis/administração & dosagem , Cloreto de Sódio/administração & dosagem , Cooperação do Paciente , Irrigação Terapêutica/métodosRESUMO
BACKGROUND/AIMS: Proper colon preparation in children has been a challenge for many years. Different regimens have been used for this purpose, but the best regimen is not determined. The aim of this study was to evaluate successful colon preparation before colonoscopy in children who were treated with one- or two-day regimen with polyethylene glycol (PEG) plus bisacodyl and clear liquids. MATERIALS AND METHODS: In this randomized clinical trial, 100 children (2-14 years old) who were candidates for colonoscopy were enrolled and divided into two groups. The children in group one were started on 2 g/kg PEG powder (17 g in 240 mL water or another beverage) and 5 mg bisacodyl suppository (BD) the day before colonoscopy, whereas those in the other group were started on 1.5 g/kg PEG with fruit juices for two days and 5 mg bisacodyl suppository (BD) for two days before colonoscopy. RESULTS: Compliance rates, regimens, adverse effects, and complete colonoscopy were not significantly different between the two groups. The Boston score was excellent and good in 70% of group one and 72% of group two children, respectively. Compliance rate, adverse effects, and need for enema were similar in both groups. The rate of compliance and non-requirement of enema were significantly higher in children with satisfactory colon preparation. CONCLUSION: The one-day PEG plus bisacodyl regimen for bowel preparation is as effective as the two-day regimen in children; furthermore, it is well tolerated and has low adverse effects.
Assuntos
Bisacodil/administração & dosagem , Catárticos/administração & dosagem , Colonoscopia , Polietilenoglicóis/administração & dosagem , Adolescente , Criança , Pré-Escolar , Colonoscopia/métodos , Esquema de Medicação , Enema , Feminino , Humanos , Masculino , Cooperação do PacienteRESUMO
BACKGROUND: Colonoscopy is an important diagnostic and therapeutic procedure. Adequate bowel preparation is mandatory. Several regimens were discussed in the literature. Among the drugs which has recently used, polyethylene glycol is one of the most popular agents. OBJECTIVES: The aim of this study was to compare efficacy of three different methods for 1 day preparation before colonoscopy. METHODS: This study included children with the range of ages (2-21) who had an indication of colonoscopy. Exclusion criteria were based on the history of previous surgery, parental disagreement, and patients who did not use preparation protocol. Three methods for bowel preparation were studied: 1- Polyethylene glycol only; 2- Polyethylene glycol and bisacodyl suppositories; 3- Polyethylene glycol plus normal saline enema. Boston Bowel Preparation Score was used for evaluation of preparation. SPSS version 16.0 (Chicago, IL, USA) were used for data analysis. RESULTS: In this study 83 cases completed the bowel preparation completely. Acceptable bowel preparation was seen in 24 (85.71%), 36 (94.73%), and 14 (82.35%) of cases in PEG, PEG + bisacodyl, and PEG + normal saline enema groups respectively. PEG + bisacodyl suppositories was more effective than PEG + normal saline for the preparation of the first segment ( P=0.05). For second and third segment of colon, BPPS score was higher in PEG + bisacodyl suppositories compared to other regimens, but this difference was not statistically significant. CONCLUSION: There was no significant difference between 1 day colonoscopy regimens in terms of bowel preparation score. Lowest score was seen in PEG + enema group compared to other group.
Assuntos
Bisacodil/administração & dosagem , Catárticos/administração & dosagem , Colonoscopia/métodos , Polietilenoglicóis/administração & dosagem , Cloreto de Sódio/administração & dosagem , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Cooperação do Paciente , Irrigação Terapêutica/métodos , Adulto JovemRESUMO
Colonoscopy is the method of choice for colorectal cancer screening. To be effective, screening colonoscopy must have high quality standards. The key element is the quality of the preparation. However, up to 20% of patients are inadequately prepared and, at present, anterograde washing is the least tolerated part of the procedure. In the choice of preparation, safety is a prerequisite and efficacy is a priority. Tolerance is a secondary but nevertheless influential factor in the quality of preparation and has consequently been the primary focus of many recent studies. In the last few years, a rapidly increasing number of studies have evaluated new drugs, dosages and adjuvant therapies to improve efficacy and tolerability. These studies have collaterally shown that inadequate preparation and lack of adherence to the prescribed regimen can be partially predicted, making it essential to identify this patient subgroup and invest the necessary effort in their instruction. New individualized and flexible approaches are expected for the different clinical scenarios. The search for the ideal colonoscopy preparation, which would be tolerable, safe and above all effective, remains open.
Assuntos
Catárticos/administração & dosagem , Colonoscopia/métodos , Detecção Precoce de Câncer/métodos , Bisacodil/administração & dosagem , Catárticos/efeitos adversos , Citratos/administração & dosagem , Ácido Cítrico/administração & dosagem , Colonoscopia/tendências , Neoplasias Colorretais/diagnóstico , Fibras na Dieta , Detecção Precoce de Câncer/tendências , Previsões , Humanos , Compostos Organometálicos/administração & dosagem , Aceitação pelo Paciente de Cuidados de Saúde , Fosfatos/administração & dosagem , Picolinas/administração & dosagem , Polietilenoglicóis/administração & dosagem , Polietilenoglicóis/efeitos adversos , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Extrato de Senna/administração & dosagem , Senosídeos , Irrigação TerapêuticaRESUMO
AIM: To evaluate the efficacy of same-day bowel preparation with Senna alkaloids combined with bisacodyl tablets in routine colonoscopy procedures. METHODS: Between March and June 2013, a same-day bowel preparation was implemented in our endoscopy unit. The preparation consisted of a semi-liquid, fiber-free diet one day prior to the procedure, with two bisacodyl tablets after lunch and dinner, and 250 mL of Senna alkaloid with 1.5 L of drinking water at 6 am the day of the procedure. The quality control parameters of colonoscopy were evaluated and implemented according to the guidelines of the American Society for Gastrointestinal Endoscopy. The pre-procedure, during-procedure and post-procedure patient data were collected and analyzed: (1) pre-procedure (age, gender, comorbid diseases, colonoscopy indications, complete lack of compliance with the bowel preparation protocol); (2) during-procedure (sedation dose, duration of colonoscopy, withdrawal time, cecal intubation rate, polyp detection rate, Boston Bowel Preparation Scores and presence of foam and clear liquid); and (3) post-procedure (visual analogue scale score, pain during the procedure, patient satisfaction and premature withdrawal due to the insufficient bowel preparation). RESULTS: A total of 75 patients were included in this study with a mean age of 54.64 ± 13.29 years; 53.3% (40/75) were female and 46.7% (35/75) were male. A complete lack of compliance with the bowel preparation protocol was seen in 6.7% of patients (5/75). The mean total duration of colonoscopy was 16.12 ± 6.51 min, and the mean withdrawal time was 8.89 ± 4.07 min. The cecal intubation rate was 93.8% (61/64) and the polyp detection rate was 40% (30/75). The mean Boston Bowel Preparation Score was 7.38 ± 1.81, with the following distribution: right colon, 2.34 ± 0.89; transverse colon, 2.52 ± 0.67; left colon, 2.52 ± 0.63. The mean visual analogue scale score was 4.59 ± 1.57. Due to insufficient bowel preparation, seven patients (7/75; 9.3%) were asked to repeat the procedure. Of these, five patients had poor or modest compliance with the protocol, and two patients reported constipation. Premature withdrawal due to insufficient bowel preparation was 2.7% (2/75). The overall satisfaction with the protocol was 86.7% (65/75), with patients reporting they would prefer the same protocol in a repeat procedure. CONCLUSION: The same-day administration of Senna alkaloids appears to be a safe and effective bowel cleansing protocol for colonoscopy procedures.
Assuntos
Alcaloides/administração & dosagem , Bisacodil/administração & dosagem , Catárticos/administração & dosagem , Colonoscopia , Extrato de Senna/administração & dosagem , Administração Oral , Adulto , Idoso , Esquema de Medicação , Feminino , Humanos , Hipnóticos e Sedativos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Satisfação do Paciente , Projetos Piloto , Valor Preditivo dos Testes , Comprimidos , Fatores de Tempo , TurquiaRESUMO
BACKGROUND/AIMS: We performed a meta-analysis to compare the efficacies of vegetable oil based bisacodyl (VOB) and polyethylene glycol based bisacodyl (PGB) suppositories in treating patients with neurogenic bowel dysfunction (NBD) after spinal cord injury (SCI). MATERIALS AND METHODS: Relevant clinical studies (up to February 2014) were retrieved through the following databases: PubMed, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CCTR), Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wanfang, and VIP database for Chinese Technical Periodicals. Data were analyzed using the standardized weighted mean difference (SMD) and its 95% confidence interval (CI). P-values <0.05 were considered statistically significant. RESULTS: A total of 3 studies were included in the meta-analysis. The SMD and its 95% CI were not calculated owing to unreported standard deviations in the individual studies. The average and p-values of statistical difference indicated that the total bowel care time (p<0.05), time to flatus (p<0.05), and defecation period (p<0.05) were shorter in patients treated with PGB than in patients treated with VOB. No significant difference was observed in time to clean up (p>0.05) between patients in the PGB and VOB groups. CONCLUSION: Based on the results, we conclude that the PGB suppository could act faster than the VOB suppository in the treatment of NBD in patients with SCI.
Assuntos
Bisacodil/administração & dosagem , Intestino Neurogênico/tratamento farmacológico , Óleos de Plantas/uso terapêutico , Polietilenoglicóis/uso terapêutico , Solventes/uso terapêutico , Traumatismos da Medula Espinal/complicações , Catárticos/administração & dosagem , Defecação , Humanos , Higiene , Intestino Neurogênico/etiologia , Veículos Farmacêuticos , Supositórios , Fatores de TempoRESUMO
OBJECTIVE: To compare a 2 day bowel preparation regime of barium, iodine and a mild stimulant laxative with a 1 day iodine-only regime for CT colonography (CTC). METHODS: 100 consecutive patients underwent CTC. The first 50 patients (Regime 1) ingested 1 bisacodyl tablet twice a day 3 days before CTC and 1 dose each of 50 ml of barium and 20 ml of iodinated contrast per day starting 2 days before CTC. The second 50 patients (Regime 2) ingested 3 doses of iodinated contrast over 24 h prior to CTC. Volumes of residual stool and fluid, and the effectiveness of stool and fluid tagging, were graded according to methods established by Taylor et al (Taylor S, Slaker A, Burling D, Tam E, Greenhalgh R, Gartner L, et al. CT colonography: optimisation, diagnostic performance and patient acceptability of reduced-laxative regimens using barium-based faecal tagging. Eur Radiol 2008; 18: 32-42). A 3 day low-residue diet was taken by both cohorts. Questionnaires rating the side-effects and burden of the bowel preparation were compared to a control cohort of patients undergoing barium enema. RESULTS: The proportion of colons producing none/scattered stool (score 1) was 90.3% with Regime 1 and 65.0% with Regime 2 (p<0.005). Any residual stool was significantly better tagged with Regime 1 (score 5), with 91.7% of Regime 1 exhibiting optimum tagging vs 71.3% of Regime 2 (p<0.05). No significant differences in side-effects between the bowel preparation regimes for CTC were elicited. Bowel preparation for barium enema was tolerated significantly worse than both of the CTC bowel preparation regimes. CONCLUSION: Regime 1, containing a 3 day preparation of a mild laxative, barium and iodine, produced a significantly better prepared colon, with no difference in patient acceptability.
Assuntos
Catárticos/administração & dosagem , Colonografia Tomográfica Computadorizada/métodos , Meios de Contraste/administração & dosagem , Laxantes/administração & dosagem , Idoso , Análise de Variância , Anemia Ferropriva/etiologia , Sulfato de Bário/administração & dosagem , Bisacodil/administração & dosagem , Líquidos Corporais , Colonografia Tomográfica Computadorizada/normas , Neoplasias Colorretais/diagnóstico , Diatrizoato de Meglumina/administração & dosagem , Combinação de Medicamentos , Enema/métodos , Fezes , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Iodo/administração & dosagem , Masculino , Satisfação do Paciente , Estudos Prospectivos , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Despite the wealth of research investigating bowel cleansing efficacy, there are very little data on the timing or frequency of bowel movements after each agent is ingested. OBJECTIVE: To examine the effect of each component of a three-day combined sodium picosulphate/magnesium citrate (PSLX) and bisacodyl regimen on the timing and frequency of bowel activity in patients undergoing colonoscopy. METHODS: Outpatients booked for colonoscopy were asked to complete a diary of their bowel preparation that tracked the timing of bowel movements. Bowel preparation quality was assessed using the Ottawa Bowel Preparation Scale. Bowel activity was compared with baseline and correlated with colon cleansing. Subgroup analysis was performed examining the effect of timing of the procedure and split-dose regimens. RESULTS: One hundred patients undergoing colon cleansing received bisacodyl 10 mg at 17:00 three days and two days before the day of colonoscopy. In one group, both sachets of PSLX were given the night before colonoscopy, while the second group, whose colonoscopies were scheduled after 11:00, ingested one sachet the night before and the second sachet at 06:00 on the day of colonoscopy. Patients had a mean of 1.7 bowel movements per day in the seven days before starting the cleansing regimen. Both doses of bisacodyl tablets resulted in a significant increase in the mean number of bowel movements compared with baseline (3.3/day first dose; 3.8/day second dose [P=0.03 and 0.001, respectively]). Each dose of PSLX also resulted in a significant increase in bowel movement frequency compared with baseline, with means of 4.4, 6.3 and 4.5 bowel movements after each dose. The mean time to the final bowel movement following the second sachet of PSLX was 8.9 h when taken the night before, and 3.9 h when taken the morning of the procedure. Bowel preparation quality significantly correlated with bowel frequency when total bowel movements were considered and when only the effects of bisacodyl were accounted for (P<0.01 for each). DISCUSSION: These data demonstrate that the addition of bisacodyl before PSLX ingestion has a significant additive effect on bowel frequency and correlates with bowel cleansing quality. The timing of the resulting bowel movements have practical implications for sleep and travel times to endoscopy suites.
Assuntos
Bisacodil/administração & dosagem , Catárticos/administração & dosagem , Ácido Cítrico/administração & dosagem , Colonoscopia/métodos , Compostos Organometálicos/administração & dosagem , Cuidados Pré-Operatórios/métodos , Sulfatos/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Laxantes/administração & dosagem , Masculino , Pessoa de Meia-Idade , Comprimidos , Adulto JovemRESUMO
BACKGROUND/AIMS: good colonic preparation is essential to perform a complete and safe colonoscopy. The preparation used in the Endoscopy Unit was adopted after testing it against the classic 4-liter polyethylene glicol (PEG) preparation (Klean-Prep). Recently a new 3-liter PEG preparation was commercialised in Portugal, Endo-Falk, which appeared to be simpler and effective. The present study compared the preparation we usually use (a combination of 4 tablets of bisacodyl with 2-liter PEG and enemas) with this new preparation. METHODOLOGY: we enrolled 305 patients in 2 groups. Group 1 was given our usual preparation, as described above and group 2 was given the new 3-liter preparation, Endo-Falk. All patients were ambulatory, and only patients undergoing total colonoscopies were included. Patients with benign or malignant stenosis and patients who had previously undergone colorectal resection were excluded. Preparation was graded as good when there were no stools and little liquid in the colon, fair when there were stools or liquid that could be aspirated and did not obscure the mucosa and bad when stools or excess liquid prevented an adequate view of the surface or precluded polipectomy. RESULTS: The present study included 164 male and 141 female patients, with a mean age of 61.3 years (no difference between the demographic data). In group 1 the preparation was good in 57.5%, fair in 28.5% and bad in 14% of patients and in group 2 the preparation was good in 33.1%, fair in 48.9% and bad in 18% (p < 0.001). Colonoscopies were complete in 89.9% of all patients. CONCLUSIONS: The usual preparation was better than the new 3-liter PEG solution.
Assuntos
Bisacodil/administração & dosagem , Catárticos/administração & dosagem , Colonoscopia , Enema/métodos , Polietilenoglicóis/administração & dosagem , Tensoativos/administração & dosagem , Administração Oral , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The aim of this prospective study was to compare the efficacy and patient compliance of an oral high dose of bisacodyl plus water lavage and oral sodium phosphate in adults undergoing elective colonoscopy. METHODS: A total of 276 patients were randomized to receive an oral high-dose bisacodyl preparation (6 tablets of 5mg bisacodyl) plus water lavage (2 L of water) or an oral sodium phosphate (NaP) preparation (90 mL in divided doses). All endoscopic procedures were conducted in the afternoon. The endoscopist was blinded to the preparation the patient had received and graded the quality of colon cleansing as excellent, good, fair, poor, or failed. Patients' demographic data, indications for the procedure, and colonoscopic findings were recorded and compared. RESULTS: Significantly improved (p < 0.001) bowel preparation after NaP compared with bisacodyl plus water lavage was reported. The completion rate of colonoscopy was significantly lower (p < 0.001) in the bisacodyl group (70.6%) than in the NaP group (92.9%). The detection of polyps was significantly increased (p = 0.017) in the NaP group (43.1%) compared with the bisacodyl group (27.1%). A procedural indication of constipation was an independent predictor of failed preparation in the bisacodyl group (odds ratio, 4.8; 95% confidence interval, 1.9-12.0; p < 0.001). CONCLUSION: The quality of bowel preparation with oral NaP was better than that with bisacodyl plus water lavage.
Assuntos
Bisacodil/administração & dosagem , Catárticos/administração & dosagem , Colonoscopia/métodos , Fosfatos/administração & dosagem , Irrigação Terapêutica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
OBJECTIVES: To compare the outcome and complications of urinary diversion using ileum, with and without bowel preparation. Recent studies have questioned the necessity of bowel preparation, especially for urinary diversion when ileum is used. METHODS: In this clinical trial, 30 candidates for urinary diversion underwent a 3-day standard bowel preparation (group 1), and 32 were admitted 24 hours before surgery and received only a soft diet, with no oral intake, 8 hours before surgery (group 2). They were followed up for at least 6 months and were evaluated for outcome and surgical complications. RESULTS: All surgical operations were performed successfully using ileum. Postoperative complications were documented in 2 and 4 patients in groups 1 and 2, respectively (relative risk 0.69, 95% confidence interval 0.37 to 1.31, P = 0.41). Anastomotic leak, enterocutaneous fistula, and wound infection and dehiscence occurred in 1 patient in group 1, leading to reoperation. One case of ileus was also seen in group 1. In group 2, wound infection and dehiscence occurred 2 in patients and ileus in 2 others. CONCLUSIONS: This study failed to demonstrate any advantage of bowel preparation for urinary diversion when we use the ileal segment. Furthermore, a meticulous use of ileum can be done without the need for a colon segment in bladder substitution procedures.
Assuntos
Catárticos/administração & dosagem , Dieta , Enema , Cuidados Pré-Operatórios , Derivação Urinária , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bisacodil/administração & dosagem , Óleo de Rícino/administração & dosagem , Criança , Feminino , Humanos , Íleo/cirurgia , Complicações Intraoperatórias , Masculino , Pessoa de Meia-Idade , Complicações Pós-OperatóriasRESUMO
INTRODUCTION: Colonoscopy is the procedure of choice for the detection and ablation of small lesions o the colonic mucosa. A proper bowel cleansing is mandatory. So far several regimens have been proposed but rather none has shown a clear-cut advantage over the others. Aim of this study was to compare cleansing ability and patients' compliance of three oral regimens. PATIENTS AND METHODS: Two-hundred and seventy-three patients were block randomised into three groups. Group A (92 patients) received tablets containing senna 12 mg and Magnesium Sulphate 15 mg the day before colonoscopy. Group B (98 patients) received a Polyethylene Glycol-based solution of two litres plus 4 tablets of Bisacodyl the day before the exam. Group C (83 patients) received Sodium Phosphate 40 milliliters the day before and the day of colonoscopy. Results of 265 patients were available for the analysis. Eight patients were excluded because inability to follow prescription. The lower incidence of constipation in group C was not significant. The other parameters were homogeneously distributed in the three groups. RESULTS: The 79 patients of the group C achieved a better bowel cleansing as compared with the 90 of group A (p = 0.0003) and the 96 of group B (p = 0.034). Constipated patients had a significantly better cleansing with Sodium Phosphate preparation compared with senna plus Magnesium Sulphate (p = 0.017), but not significantly better compared with Golytely solution. Compliance and rate of total colonoscopy performed were not statistically different in the three groups. CONCLUSIONS: Sodium Phosphate solution gave better bowel preparation, with the same compliance, than either senna or Polyethylene solution. In constipated patients Sodium Phosphate showed good efficacy resulting in good cleansing rates similar to that of non-constipated patients. The poor results obtained by Polyethylene were related to the little amount of solution taken even if associated to Bisacodyl.
Assuntos
Catárticos/administração & dosagem , Colonoscopia , Fosfatos , Idoso , Antraquinonas/administração & dosagem , Bisacodil/administração & dosagem , Distribuição de Qui-Quadrado , Eletrólitos/administração & dosagem , Feminino , Humanos , Sulfato de Magnésio/administração & dosagem , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Polietilenoglicóis/administração & dosagem , Cuidados Pré-Operatórios , Extrato de Senna/administração & dosagem , Senosídeos , Soluções , Solventes/administração & dosagemRESUMO
In an attempt to improve patient tolerance for colon cleaning, a reduced-volume regimen with a 2-liter electrolyte lavage solution plus 20 mg of oral bisacodyl was compared with the standard 4-liter lavage for efficacy and safety. Three hundred patients were prospectively randomized into two study groups. One group of 150 patients was given four tablets of 5 mg bisacodyl at 12:00 PM the day before their colonoscopy, followed by 2 liters of electrolyte lavage by mouth at 6:00 PM the evening before their colonoscopy. Another group of 150 patients were given 4 liters of electrolyte lavage at 6:00 PM the evening before their colonoscopy. All patients were on a clear liquid diet the day before their colonoscopy. No enema was given in either groups. The bowel cleanliness was accessed by one colonoscopist. One registered nurse accessed the comfort of patient. In the 2-liter group, only one (0.6%) patient could not finish the laxative. Colon cleanliness was 80 per cent to 100 per cent, with an average of 95.9 per cent. In the 4-liter group, 11 (7.3%) patients could not finish the laxative preparation. Colon cleanliness was 78 per cent to 100 per cent, with an average of 95.3 per cent. The study that found the 2-liter electrolyte lavage solution with four tablets of bisacodyl can achieve equally good results in bowel preparation and favorable acceptance by patients compared with the 4-liter lavage.
Assuntos
Bisacodil/administração & dosagem , Catárticos/administração & dosagem , Colo/efeitos dos fármacos , Colonoscopia , Dor Abdominal/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bisacodil/efeitos adversos , Catárticos/efeitos adversos , Colo/patologia , Colonoscopia/métodos , Eletrólitos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Náusea/etiologia , Satisfação do Paciente , Polietilenoglicóis/administração & dosagem , Polietilenoglicóis/efeitos adversos , Estudos Prospectivos , Método Simples-Cego , Irrigação Terapêutica/métodos , Vômito/etiologiaRESUMO
This study examined whether the combination of a single dose (45 ml) oral sodium phosphate (NaP), four bisacodyl tablets (5 mg), and one bisacodyl enema (10 mg) preparation, Fleet Prep Kit 3 (FPK #3), was better tolerated and more efficacious than 4 L polyethylene glycol solution (PEG) for colonic cleansing prior to colonoscopy. One hundred and seventy-one patients were enrolled in this prospective, randomized, single-blinded study designed to detect a 20% or greater difference in patient tolerance and effectiveness in colonic cleansing between the two agents. The single dose of NaP and the bisacodyl tablets were administered at 1900 h and at 2100 h, respectively, the evening prior to colonoscopy and the bisacodyl enema 2 h before the procedure. PEG was consumed over 1-2 h the evening prior to colonoscopy. Most patients (84%) found the FPK #3 easy or tolerable compared to only 33% receiving PEG (p < 0.001). Over 40% could not complete the PEG. There was no detectable difference in the efficacy between the two preparations (p= 0.74). Comparison of biochemical and hemodynamic values obtained before and after colonic cleansing did not reveal any significant differences apart from hyperphosphatemia in a few patients (16%) receiving FPK #3 and minor changes in blood urea nitrogen and chloride. These findings suggest that FPK #3 is better tolerated and as safe as PEG but does not provide more efficacious cleansing of the colon.
Assuntos
Bisacodil/administração & dosagem , Catárticos/administração & dosagem , Colonoscopia , Fosfatos/administração & dosagem , Polietilenoglicóis/administração & dosagem , Administração Oral , Bisacodil/efeitos adversos , Catárticos/efeitos adversos , Enema , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Fosfatos/efeitos adversos , Polietilenoglicóis/efeitos adversos , Método Simples-CegoRESUMO
OBJECTIVE: The objective of this report is to describe a cost-effective strategy for management of constipation in nursing home residents with dementia. DESIGN: We conducted a prospective observational quality improvement study of 41 residents with chronic constipation and receiving an osmotic laxative. Sorbitol was substituted for lactulose. SETTING: The study was conducted at a dementia special care unit at a Veterans Administration hospital. MEASUREMENT: We measured the number and amount of laxative use over a period of 4 weeks that were required to maintain regular bowel function. RESULTS: There was no difference in efficacy of lactulose and sorbitol. Use of additional laxatives was infrequent: Milk of Magnesia on approximately 10% of days/patient, bisacodyl suppository on 2% to 4% of days/patient, and Fleet enema only on 3 occasions. The cost of constipation management using routine administration of sorbitol and as-needed use of other laxatives was 27% to 55% lower than the cost of other constipation management strategies reported in the literature. CONCLUSION: Substitution of sorbitol for lactulose does not change efficacy of the treatment and decreases cost. Regular use of an osmotic laxative avoids the costs and discomforts of rectal laxatives.
Assuntos
Catárticos , Constipação Intestinal/tratamento farmacológico , Constipação Intestinal/economia , Demência/complicações , Custos de Medicamentos , Casas de Saúde , Sorbitol , Idoso , Idoso de 80 Anos ou mais , Bisacodil/administração & dosagem , Bisacodil/economia , Catárticos/administração & dosagem , Catárticos/economia , Doença Crônica , Constipação Intestinal/fisiopatologia , Análise Custo-Benefício , Demência/fisiopatologia , Enema/economia , Feminino , Humanos , Lactulose/administração & dosagem , Lactulose/economia , Óxido de Magnésio/administração & dosagem , Óxido de Magnésio/economia , Masculino , Casas de Saúde/estatística & dados numéricos , Estudos Prospectivos , Sorbitol/administração & dosagem , Sorbitol/economia , Fatores de TempoAssuntos
Constipação Intestinal/terapia , Biorretroalimentação Psicológica , Bisacodil/administração & dosagem , Bisacodil/uso terapêutico , Catárticos/administração & dosagem , Catárticos/uso terapêutico , Doença Crônica , Colectomia , Colo Sigmoide/cirurgia , Constipação Intestinal/dietoterapia , Constipação Intestinal/cirurgia , Fibras na Dieta/administração & dosagem , Exercício Físico , Glicerol/administração & dosagem , Glicerol/uso terapêutico , Humanos , Estilo de Vida , Satisfação do Paciente , Supositórios , Fatores de TempoRESUMO
Our initial attempts at implementing a high-volume clinic were impeded by the quality of colon preparation. While two Fleet enema preparations were generally easy to administer and well tolerated, the results were frequently poor. Current studies are limited and opinions vary regarding the most effective bowel preparation. The purpose of this study was to compare three forms of bowel preparation for screening flexible sigmoidoscopy. All patients scheduled for screening flexible sigmoidoscopy were given one of three colon preparations: two Fleet enemas; magnesium citrate orally the evening before, clear liquid diet and two Dulcolax suppositories the day of the exam; or magnesium citrate orally the evening before, clear liquid the day of the exam, and two Fleet enemas 1 hour before the procedure. Examinations were performed using a video flexible sigmoidoscopy by specialty trained gastroenterologists. Physicians were asked to rate the preparations as excellent, good, fair, or poor according to explicit criteria, and to document depth of insertion. Results showed that the magnesium citrate and Fleet enema preparation was excellent for 70% of patients, allowing for greater depth of insertion. Need for repeat examination due to poor preparation was infrequent with this group and patient tolerance of the preparation was acceptable.
Assuntos
Catárticos/administração & dosagem , Enema , Sigmoidoscopia/métodos , Análise de Variância , Bisacodil/administração & dosagem , Ácido Cítrico/administração & dosagem , Dieta , Humanos , Pessoa de Meia-Idade , Compostos Organometálicos/administração & dosagem , SupositóriosRESUMO
BACKGROUND: The best and most cost-effective bowel cleansing regimen for patients undergoing flexible sigmoidoscopy is not known. The aim of this study was to compare patient tolerance, quality of preparation, and cost of 2 bowel cleansing regimens for flexible sigmoidoscopy. METHODS: Two hundred fifty consecutive patients referred for screening flexible sigmoidoscopy were randomized to receive an oral preparation (45 mL oral sodium phosphate and 10 mg bisacodyl) or an enema preparation (2 Fleet enemas and 10 mg bisacodyl). Tolerance of the preparation was graded as easy, tolerable, slightly difficult, extremely difficult, or intolerable. The endoscopist was blinded to which preparation the patient received and graded the quality of the preparation as poor, fair, good, or excellent. Cost was calculated by adding the cost of the medications and the cost for the nursing time required to prepare the patient for endoscopy. RESULTS: Patients in the oral preparation group were more likely to grade the preparation as easy or tolerable when compared with the enema group (96.8% vs. 56.4%, p < 0.001). The endoscopist graded the quality of the preparation as good or excellent in 86.5% of the patients in the oral preparation group compared with 57.3% in the enema group (p < 0.001). In the oral preparation group, the mean nursing time (34.6 vs. 65.3 minutes, p < 0.001) and cost ($16.39 vs. $31.13, p < 0.001) were significantly less than in the enema group. CONCLUSIONS: An oral sodium phosphate preparation results in a superior quality endoscopic examination that is better tolerated and more cost-effective than enemas in patients undergoing screening flexible sigmoidoscopy.