Effect of bisacodyl on rats with slow transit constipation.

The effect of bisacodyl on the treatment of rats with slow transit constipation (STC) was studied. Forty-five female Wister rats were divided into control group, STC group, and STC bisacodyl group. The immunohistochemical method was used to determine interstitial cells of Cajal (ICC) and the expression of c-Kit protein. Body mass and the number of defecations were significantly decreased in the STC group compared with the control group on the 100th day after diphenoxylate administration, while dry weight of feces was significantly increased and the intestinal transit time was prolonged. There were significant differences in the number of defecations, dry weight of feces, and intestinal transit time among the three groups. The number of defecations was higher, dry weight of feces was lower, and intestinal transit time was shorter in the STC bisacodyl group compared to the STC group. In addition, ICC basement membrane dissolution occurred in the colon wall of the STC group. The connection between ICC and surrounding cells was destroyed, and the nucleus shrunken to different degrees. Moreover, c-Kit expression in the STC group was significantly lower than the control group. The connection between ICC and surrounding cells in the STC bisacodyl group was significantly stronger than the STC group, and the number of ICC and the expression of c-Kit were increased. Bisacodyl could reduce the severity of STC in rats by increasing the number of ICC and the expression of c-Kit.

Effect of bisacodyl on rats with slow transit constipation

The effect of bisacodyl on the treatment of rats with slow transit constipation (STC) was studied. Forty-five female Wister rats were divided into control group, STC group, and STC bisacodyl group. The immunohistochemical method was used to determine interstitial cells of Cajal (ICC) and the expression of c-Kit protein. Body mass and the number of defecations were significantly decreased in the STC group compared with the control group on the 100th day after diphenoxylate administration, while dry weight of feces was significantly increased and the intestinal transit time was prolonged. There were significant differences in the number of defecations, dry weight of feces, and intestinal transit time among the three groups. The number of defecations was higher, dry weight of feces was lower, and intestinal transit time was shorter in the STC bisacodyl group compared to the STC group. In addition, ICC basement membrane dissolution occurred in the colon wall of the STC group. The connection between ICC and surrounding cells was destroyed, and the nucleus shrunken to different degrees. Moreover, c-Kit expression in the STC group was significantly lower than the control group. The connection between ICC and surrounding cells in the STC bisacodyl group was significantly stronger than the STC group, and the number of ICC and the expression of c-Kit were increased. Bisacodyl could reduce the severity of STC in rats by increasing the number of ICC and the expression of c-Kit.

Tolerancia, seguridad y eficacia de la preparación intestinal con un día de PEG3350 + bisacodilo en comparación con 2 días de PEG3350 + bisacodilo en pacientes pediátricos / Tolerance, safety and efficacy of the one-day preparation of PEG3350 + bisacodyl compared to 2 days of PEG3350 + bisacodyl in pediatric patients

Resumen: Introducción: Múltiples preparaciones intestinales se han utilizado en niños sometidos a una colonoscopia, con limitación variable debido a la aceptación, tolerancia y la limpieza adecuada. El objetivo del estudio fue comparar la tolerancia seguridad y eficacia de la preparación intestinal para colonoscopia de 1 día con PEG 3350 (polietilenglicol) (4 g/kg/día) + bisacodilo y el tratamiento con 2 días de preparación con PEG 3350 (2 g/kg/día) + bisacodilo en pacientes pediátricos. Métodos: Se realizó un ensayo clínico, aleatorizado y ciego. Se incluyeron pacientes de 2 a 18 años, que ameritaron colonoscopia en forma programada. Los pacientes se asignaron de manera aleatoria en dos grupos: 1 día de preparación con PEG 3350 4 g/kg/día + bisacodilo y 2 días de preparación con PEG 3350 2 g/kg/día + bisacodilo. Por medio de un cuestionario, exploración física y valoración endoscópica (escala de Boston), se determinó la tolerancia, seguridad y eficacia de las 2 preparaciones a evaluar. Se realizó una prueba t de Student para variables cuantitativas y χ2 para variables cualitativas. Resultados: No hubo diferencias significativas en las tasas de cumplimiento, los efectos adversos y la extensión de la evaluación colonoscópica. Conclusiones: La tolerancia y seguridad entre la preparación intestinal para colonoscopia de 1 día con PEG 3350 (polietilenglicol) (4 g/kg/día) + bisacodilo y la preparación de 2 días con PEG 3350 (2 g/kg/día) + bisacodilo fue semejante. La calidad de la limpieza fue buena en ambos grupos, siendo parcialmente más eficaz en el grupo de 1 día con PEG 3350 (polietilenglicol) (4 g/kg/día).

Abstract: Background: Multiple intestinal preparations have been used in children undergoing colonoscopy, with variable limitation due to acceptance, tolerance, and proper cleaning. The objective of this study was to compare the tolerability, safety and efficacy of the colonoscopy preparation with 1 day with PEG 3350 (poliethylenglycol) (4 g/kg/day) + bisacodyl compared to 2 days of preparation with PEG 3350 (2 g/kg/day) + bisacodyl in pediatric patients. Methods: A clinical, randomized, and blind trial was performed. Patients aged 2 to 18 years scheduled for colonoscopy were included. Patients were randomized into two groups: 1 day of preparation with PEG 3350 4 g/kg/day + bisacodyl and 2 days of preparation with PEG 3350 2 g/kg/day + bisacodyl. Through a questionnaire, physical examination and endoscopic evaluation (Boston scale), the tolerance, safety and efficacy of the 2 preparations to be evaluated were determined. Student's t test was performed for quantitative variables and χ2 for qualitative variables. Results: There were no significant differences in compliance rates, adverse effects, and extent of colonoscopic evaluation. Conclusions: Tolerance and safety between the intestinal preparation for 1-day colonoscopy with PEG 3350 (4 g/kg/day) + bisacodyl and the 2-day preparation with PEG 3350 (2 g/kg/day) + bisacodyl were similar. The quality of cleanliness was good in both groups, being partially more effective in the 1-day group with PEG 3350 (4 g/kg/day).

[Tolerance, safety and efficacy of the one-day preparation of PEG3350 + bisacodyl compared to 2 days of PEG3350 + bisacodyl in pediatric patients]. / Tolerancia, seguridad y eficacia de la preparación intestinal con un día de PEG3350 + bisacodilo en comparación con 2 días de PEG3350 + bisacodilo en pacientes pediátricos.

BACKGROUND: Multiple intestinal preparations have been used in children undergoing colonoscopy, with variable limitation due to acceptance, tolerance, and proper cleaning. The objective of this study was to compare the tolerability, safety and efficacy of the colonoscopy preparation with 1 day with PEG 3350 (poliethylenglycol) (4g/kg/day) + bisacodyl compared to 2 days of preparation with PEG 3350 (2g/kg/day) + bisacodyl in pediatric patients. METHODS: A clinical, randomized, and blind trial was performed. Patients aged 2 to 18 years scheduled for colonoscopy were included. Patients were randomized into two groups: 1 day of preparation with PEG 3350 4g/kg/day + bisacodyl and 2 days of preparation with PEG 3350 2g/kg/day + bisacodyl. Through a questionnaire, physical examination and endoscopic evaluation (Boston scale), the tolerance, safety and efficacy of the 2 preparations to be evaluated were determined. Student's t test was performed for quantitative variables and χ2 for qualitative variables. RESULTS: There were no significant differences in compliance rates, adverse effects, and extent of colonoscopic evaluation. CONCLUSIONS: Tolerance and safety between the intestinal preparation for 1-day colonoscopy with PEG 3350 (4g/kg/day) + bisacodyl and the 2-day preparation with PEG 3350 (2g/kg/day) + bisacodyl were similar. The quality of cleanliness was good in both groups, being partially more effective in the 1-day group with PEG 3350 (4g/kg/day).

Evaluación económica de tecnologías para el tratamiento del estreñimiento en Colombia / Economic evaluation of technologies for the treatment of constipation in Colombia

INTRODUCCIÓN: El estreñimiento crónico funcional se define como la presencia de movimientos intestinales infrecuentes asociados a la coexistencia de síntomas como materia fecal dura y en bultos, esfuerzo defecador, sensación de evacuación incompleta y distensión abdomina. El estreñimiento crónico se clasifica en dos categorías: idiopático (primario) y secundario. El estreñimiento primario es un trastorno basado en síntomas que resultan de una disfunción de la regulación del movimiento de las heces junto con falta de coordinación del aparato neuromuscular anorrectal y disfunción del eje-cerebro-intestino. y farmacéuticas, siendo las últimas las más comunes. TRATAMIENTO: El tratamiento depende de si el problema es secundario a medicamentos, condiciones metabólicas, obstrucción luminal colónica o a una disfunción neuromuscular del colon; las aproximaciones generales incluyen retiro de los medicamentos predisponentes o terapias alternativas, educación sobre el estreñimiento, incremento de la ingesta de líquidos y fibra y ritualización del hábito intestinal. Existen agentes de múltiples clases para el tratamiento del estreñimiento: formadores de masa, laxantes estimulantes y osmóticos, laxantes emolientes, secretagogos y agentes serotoninérgicos. La guía de práctica clínica para el diagnóstico y tratamiento del estreñimiento crónico funcional en población. adulta, elaborada en Colombia, recomienda el polietilenglicol, lactulosa, bisacodilo, secretagogos (lubiprostone, linaclotide) y prucalopride. POBLACIÓN: Población : tres posibles poblaciones: Pacientes adultos y niños con estreñimiento crónico funcional. Pacientes adultos con estreñimiento inducido por el uso de opioides. Pacientes con estreñimiento de origen idiopático. INTERVENCIÓN: -Fosfato de sódio,-Lactulosa, -Picosulfato de sódio, -Picosulfato de sodio combinaciones, -Polietilenglicol (PEG) sin electrolitos, -Bisacodilo, -Secretagogos (lubiprostone o linaclotide), -Prucaloprida, -Hidróxido de magnesio sin alumínio. PERSPECTIVA: Se empleará la perspectiva del sistema de salud colombiano, es decir, serán incluidos los costos médicos directos asociados al uso de las tecnologías en salud que son objeto de la evaluación y los beneficios en salud percibidos directamente por los pacientes. DESENLACES Y VALORACIÓN: De acuerdo con las recomendaciones del manual metodológico del IETS, en esta evaluación se propone emplear los AVAC (años de vida ajustados por calidad) como medida de desenlace. La información de las ponderaciones de utilidad se obtendrá de la literatura. En caso que no sea factible emplear AVAC, se emplearán otros desenlaces, que serán justificados en el informe. COSTOS: Se tendrán en cuenta todos los costos asociados a las tecnologías evaluadas y a los desenlaces en salud incluidos en el modelo de decisión planteado. Se utilizarán como fuentes de información bases de datos institucionales de validez nacional, consulta directa y otras fuentes, tal como lo estipula el manual metodológico del IETS. MODELO DE DECISIONES: Se diseñará un modelo de decisión analítico a partir de la revisión de literatura económica existente, los resultados de la evaluación de efectividad y seguridad elaborada por el IETS y la consulta a expertos clínicos y otros actores del sistema de salud relacionados con las tecnologías e indicación de interés. PRESENTACIÓN DE RESULTADOS: En el caso de tecnologías no dominadas, se calcularán las razones incrementales de costo-utilidad o costo-efectividad. Para efectos de interpretación, y de acuerdo con las recomendaciones del manual metodológico del IETS, se realizarán comparaciones entre la razón incremental y 1 PIB per cápita y 3 PIB per cápita en Colombia de acuerdo con las estimaciones actuales del Banco de la República. ANÁLISIS DE SENSIBILIDAD: Se evaluará la incertidumbre en las estimaciones mediante análisis de sensibilidad univariados y probabilísticos. Los resultados de las simulaciones de Montecarlo se presentarán mediante un diagrama de dispersión en el plano de costoefectividad y los resultados del análisis de sensibilidad probabilístico mediante curvas de aceptabilidad.

BOWEL PREPARATION BEFORE COLONOSCOPY FOR CHILDREN: comparison of efficacy of three different methods

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.

BOWEL PREPARATION BEFORE COLONOSCOPY FOR CHILDREN: comparison of efficacy of three different methods.

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.

Comparación de la preparación previa a colonoscopia con bisacodilo más lactulosa vs polietilenglicol 4 litros a dosis dividida en pacientes ambulatorios de Gastroenterología de Hospital Central FAP / Comparison of preparation prior to colonoscopy with bisacodyl more lactulose vs. polyethylene glycol 4 liters to dose divided in outpatient of the gastroenterology at the Central Hospital FAP

Introducción: La colonoscopia es el método estándar actual para la evaluación del colon y prueba de oro para la detección del cáncer de colon. La precisión del diagnóstico depende de la calidad de la limpieza o la preparación del colon, además de la habilidad o entrenamiento del profesional que la realizan. La preparación ideal para la colonoscopia debería ser la que logra el vaciamiento del contenido fecal del marco colónico de forma rápida y confiable en su totalidad sin alteración grave o histológica de la mucosa del colon. Esta preparación también no deberá producir ninguna molestia o cambios a nivel hidroelectrolítico en el paciente o efectos sobre la presión arterial o función renal, además que debe tener un bajo costo. Desafortunadamente, ninguna de las preparaciones actuales disponibles cumple todos estos requisitos. Objetivo: 1) Conocer la calidad de la preparación colónica con Bisacodilo más Lactulosa en comparación con Polietilenglicol, usando la escala de limpieza de Aronchick en pacientes mayores de 18 años del Hospital Central FAP. 2) Identificar el porcentaje de adecuada e inadecuada preparación colónica con Bisacodilo más Lactulosa y Polietilenglicol. 3) Identificar cuantos pacientes culminaron o no las preparaciones colónicas de Bisacodilo más Lactulosa y Polietilenglicol. 4) Identificar los síntomas y hallazgos endoscópicos durante el estudio con ambas preparaciones. Materiales y métodos: Estudio Observacional de tipo Transversal en el que se comparo dos preparaciones colónicas, una con Bisacodilo más Lactulosa y otra con Polietilenglicol. La población de pacientes estuvo constituida por pacientes ambulatorios que acudieron al Servicio de Gastroenterología del Hospital Central FAP durante el periodo Enero 2014 a Junio 2014. Se diseño la ficha de recolección de datos para evaluar la calidad de la preparación colónica y se analizaron los resultados utilizando el procesador de datos STATA versión 12.0. Resultados: Entre Enero del 2014 y Junio...

Introduction: Colonoscopy is the current standard method for evaluation of the colon and gold test for detecting colon cancer. Diagnostic accuracy depends on the quality of cleaning or preparing the colon, besides the ability or professional training who perform. The ideal preparation for colonoscopy should be the one that achieves the emptying of the bowel by fecal content fast and reliable fully without gross or histological alteration of the colonic mucosa. This preparation also should not cause any discomfort or changes in the patient's electrolyte levels or effects on blood pressure or renal function, also it must have a low cost. Unfortunately, none of the current preparations available meets all these requirements. Objective: 1) Knowing the quality of bowel preparation with Bisacodyl plus Lactulose vs. Polyethyleneglycol, using the Aronchick cleaning scale in patients over 18 years of Hospital Central FAP. 2) Identify the percentage of adequate and inadequate colonic preparation with Bisacodyl plus Lactulose and Polyethyleneglycol. 3) Identify how many patients culminated or not the colonic preparations with Bisacodyl plus Lactulose and Polyethyleneglycol. 4) Identify the symptoms and endoscopic findings in the study with both preparations. Methods: An observational, transversal study in which two kinds colonic preparations, one with Bisacodyl plus Lactulose and the other Polyethyleneglycol was compared. The population consisted of outpatients from Gastroenterology Service of Hospital Central FAP during the period January 2014 to June 2014. The data collection sheet was designed to assess the quality of colonic preparation and the results were analyzed using the data processor STATA version 12.0. Results: Between January to June 2014, 142 colonoscopies were performed at outpatient and inpatient Hospital Central FAP in Gastroenterology Service, 70 (49.3 per cent) were prepared with Bisacodyl plus Lactulose and 72 (50.7 per cent) were prepared with...

Colonic preparation before colonoscopy in constipated and non-constipated patients: a randomized study.

AIM: To compare the efficacy of different doses of sodium phosphate (NaP) and polyethylenglicol (PEG) alone or with bisacodyl for colonic cleansing in constipated and non-constipated patients. METHODS: Three hundred and forty-nine patients, older than 18 years old, with low risk for renal damage and who were scheduled for outpatient colonoscopy were randomized to receive one of the following preparations (prep): 90 mL of NaP (prep 1); 45 mL of NaP + 20 mg of bisacodyl (prep 2); 4 L of PEG (prep 3) or 2 L of PEG + 20 mg of bisacodyl (prep 4). Randomization was stratified by constipation. Patients, endoscopists, endoscopists' assistants and data analysts were blinded. A blinding challenge was performed to endoscopist in order to reassure blinding. The primary outcome was the efficacy of colonic cleansing using a previous reported scale. Secondary outcomes were tolerability, compliance, side effects, endoscopist perception about the necessity to repeat the study due to an inadequate colonic preparation and patient overall perceptions. RESULTS: Information about the primary outcome was obtained from 324 patients (93%). There were no significant differences regarding the preparation quality among different groups in the overall analysis. Compliance was higher in the NaP preparations being even higher in half-dose with bisacodyl: 94% (prep 1), 100% (prep 2), 81% (prep 3) and 87% (prep 4) (2 vs 1, 3 and 4, P < 0.01; 1 vs 3, 4, P < 0.05). The combination of bisacodyl with NaP was associated with insomnia (P = 0.04). In non-constipated patients the preparation quality was also similar between different groups, but endoscopist appraisal about the need to repeat the study was more frequent in the half-dose PEG plus bisacodyl than in whole dose NaP preparation: 11% (prep 4) vs 2% (prep 1) (P < 0.05). Compliance in this group was also higher with the NaP preparations: 95% (prep 1), 100% (prep 2) vs 80% (prep 3) (P < 0.05). Bisacodyl was associated with abdominal pain: 13% (prep 1), 31% (prep 2), 21% (prep 3) and 29% (prep 4), (2, 4 vs 1, 2, P < 0.05). In constipated patients the combination of NaP plus bisacodyl presented higher rates of satisfactory colonic cleansing than whole those PEG: 95% (prep 2) vs 66% (prep 3) (P = 0.03). Preparations containing bisacodyl were not associated with adverse effects in constipated patients. CONCLUSION: In non-constipated patients, compliance is higher with NaP preparations, and bisacodyl is related to adverse effects. In constipated patients NaP plus bisacodyl is the most effective preparation.

[Bowel preparation for colonoscopy: comparative study using Boston Bowel Preparation Scale]. / Estudio comparativo de tres preparaciones para colonoscopía utilizando la escala Boston Bowel Praparation Scale.

BACKGROUND: Most comparative studies on different preparations for colonic cleanliness use unvalidated scales with terms as "excellent," "good," "fair," and "poor" which lack standardized definitions. The Boston Bowel Preparation Scale (BBPS) is a valid and simple measure of bowel preparation. OBJECTIVE: To compare three different bowel preparations [polyethylenglycol (PEG), sodium phosphates, and PEG + bisacodyl tablets] using BBPS. MATERIAL AND METHODS: Patients undergoing screening colonoscopies were included during a period of 6 months. Every patient was scored according to BBPS. RESULTS: Six endoscopists prospectively enrolled 374 patients (200 female and 174 male, median age 56.9 years old). Physicians chose the preparation method, and in spite of not being a randomized trial, numbers in each group allowed statistical analysis: PEG 116patients (31%), sodium phosphates 212 (56.7%) and bisacodyl 46 (12.3%). There was statistical difference between the three preparations in favor of the 4 litre solution of PEG, with a median score of 7, towards sodium phosphates and bisacodyl, with median scores of 6 (P < 0.001). Depending on bowel preparation, there were positive polyp findings in 40% of colonoscopies with PEG, 26% with sodium phosphates and 22% with bisacodyl (P = 0.01). Afternoon procedures had better preparation scores than morning procedures, 7 and 6, respectively (P < 0.001). In the afternoon colonoscopies, there were no statisticaIly significant differences between the preparations (P = 0.12) or polyp findings (P = 0.13). In the morning shift, PEG prepared patients had better scores (score of 6) when compared to sodium phosphate (score of 5) and bisacodyl (score of 6) (P = 0.001). We also noticed that the shorter the time interval between the last intake of the preparation and the procedure, the better the score. CONCLUSIONS: Bowel preparations for colonoscopy with PEG are significantly better than sodium phosphate and bisacodyl preparations, with higher BBPS scores and polyp detection rates.

Bowel preparation for performing a colonoscopy: prospective randomized comparison study between a low-volume solution of polyethylene glycol and bisacodyl versus bisacodyl and a mannitol solution.

CONTEXT: Colonoscopy is currently the gold standard method to examine the colon, the rectum and the terminal ileum. In order to perform the colonoscopy, it is necessary to clean the bowel and use medications that are generally poorly tolerated by the patients. OBJECTIVE: Compare the tolerability, acceptability, safety and efficacy of two solutions used for intestinal preparation for a colonoscopy. METHODS: One hundred patients matched for sex and age were prospective randomized into two groups. Polyethylene glycol group received bisacodyl 10 mg plus 1 L of polyethylene glycol the night before and 1 L on the day of the exam. Mannitol group received bisacodyl 20 mg the day before and 1 L of a 10% mannitol solution on the day of the exam. The diet was the same for both groups. Tolerability and acceptability were measured using previously validated questionnaires. In terms of safety, variations in vital signs before and after the preparation were recorded, in addition to any complications. The quality of the preparation was graded based on the Boston and Ottawa scales. RESULTS: Ninety-six percent (96%) completed the study. As for tolerability, the mannitol preparation group exhibited a significantly higher frequency of nausea, vomiting, abdominal pain, and abdominal distension than polyethylene glycol group (P < 0.05). Acceptability was significantly better in polyethylene glycol group. The polyethylene glycol solution has also previously been shown to be safer than mannitol. No difference was observed in the quality of the preparation between the two preparation methods. CONCLUSIONS: The following conclusions can be made: polyethylene glycol solution had higher tolerability, acceptability, and safety than the mannitol and should be used instead of mannitol. Both preparation solutions have similar efficacy.

Bowel preparation for performing a colonoscopy: prospective randomized comparison study between a low-volume solution of polyethylene glycol and bisacodyl versus bisacodyl and a mannitol solution / Preparo de cólon para realização de colonoscopia: estudo prospectivo randomizado comparativo entre solução de polietilenoglicol baixo volume mais bisacodil versus solução de manitol mais bisacodil

CONTEXT: Colonoscopy is currently the gold standard method to examine the colon, the rectum and the terminal ileum. In order to perform the colonoscopy, it is necessary to clean the bowel and use medications that are generally poorly tolerated by the patients. OBJECTIVE: Compare the tolerability, acceptability, safety and efficacy of two solutions used for intestinal preparation for a colonoscopy. METHODS: One hundred patients matched for sex and age were prospective randomized into two groups. Polyethylene glycol group received bisacodyl 10 mg plus 1 L of polyethylene glycol the night before and 1 L on the day of the exam. Mannitol group received bisacodyl 20 mg the day before and 1 L of a 10% mannitol solution on the day of the exam. The diet was the same for both groups. Tolerability and acceptability were measured using previously validated questionnaires. In terms of safety, variations in vital signs before and after the preparation were recorded, in addition to any complications. The quality of the preparation was graded based on the Boston and Ottawa scales. RESULTS: Ninety-six percent (96%) completed the study. As for tolerability, the mannitol preparation group exhibited a significantly higher frequency of nausea, vomiting, abdominal pain, and abdominal distension than polyethylene glycol group (P < 0.05). Acceptability was significantly better in polyethylene glycol group. The polyethylene glycol solution has also previously been shown to be safer than mannitol. No difference was observed in the quality of the preparation between the two preparation methods. CONCLUSIONS: The following conclusions can be made: polyethylene glycol solution had higher tolerability, acceptability, and safety than the mannitol and should be used instead of mannitol. Both preparation solutions have similar efficacy.

CONTEXTO: O exame de colonoscopia é atualmente o padrão-ouro para investigação do cólon e íleo terminal. Para sua realização há necessidade de limpeza do cólon com soluções que, em geral, são mal toleradas pelos pacientes. OBJETIVO: Comparar duas soluções de preparo intestinal para colonoscopia quanto à tolerabilidade, aceitabilidade, segurança e efetividade. MÉTODOS: Cem pacientes pareados por sexo e idade foram randomizados prospectivamente em dois grupos. O grupo polietilenoglicol recebeu bisacodil 10 mg + 1 litro de polietilenoglicol na véspera e 1 litro no dia do exame. O grupo manitol recebeu bisacodil 20 mg na véspera e 1 litro de manitol 10% no dia do exame. A dieta foi a mesma nos dois grupos. A tolerabilidade e aceitabilidade foram aferidas por questionários previamente validados. Quanto à segurança foram avaliados: variação de sinais vitais antes e após o preparo e complicações, além de quaisquer sinais de complicação. A qualidade do preparo foi graduada através das escalas de Boston e Ottawa. RESULTADOS: Noventa e seis pacientes (96%) completaram o estudo. Quanto à tolerabilidade o grupo manitol apresentou manifestação significativamente maior de náusea, vômito, dor abdominal e distensão abdominal do que o grupo polietilenoglicol (P<0,05). Aceitabilidade foi significativamente melhor com o grupo polietilenoglicol. O grupo polietilenoglicol também se mostrou mais seguro. Não se observou diferença na qualidade do preparo entre os métodos. CONCLUSÕES: A solução de polietilenoglicol apresentou melhor tolerabilidade, aceitabilidade e segurança e deve ser usada ao invés da solução de manitol. Ambas as soluções são semelhantes em eficácia.

Preparo de cólon para colonoscopia: estudo comparativo de macrogol e lactulose com e sem bisacodil / Bowel preparation for colonoscopy: a comparative study of macrogol with and without lactulose and bisacodyl

Introdução: a colonoscopia é hoje o exame padrão ouro para avaliação das doenças colorretais. O preparo deve ser escolhido de acordo com sua eficácia, tolerabilidade e segurança na administração. A maioria dos serviços indica o preparo anterógrado, por via oral, cujos laxativos têm ação rápida e de curta duração. Pode-se associar o bisacodil, substância com ação catártica a base de difenilmetano. Todavia, há dúvidas quanto à melhora da eficácia do preparo com a associação desse produto. Objetivo: avaliar o preparo intestinal para colonoscopia comparando lactulose e macrogol, com e sem bisacodil. Método: estudo retrospectivo realizado no HSPM-SP, avaliando 211 colonoscopias com preparos feitos com lactulose e macrogol, com e sem bisacodil, realizadas entre abril e agosto de 2012. Os preparos se iniciaram com dieta sem resíduos na véspera do exame e orientação à grande ingesta hídrica. As doses utilizadas foram: GRUPO I - bisacodil, 4 drágeas (20mg) associadas a 120ml de lactulose dissolvidos em 1000ml de suco ou água; GRUPO II - lacutulose, 240ml divididos em duas tomadas de 120ml diluídos em 1000ml de suco ou água; GRUPO III - bisacodil, 4 drágeas (20mg) associadas a macrogol, 8 envelopes dissolvidos em 1000ml de suco ou água; GRUPO IV - macrogol, 16 envelopes divididos em duas tomadas de 8 envelopes dissolvidos em 1000ml de suco ou água. O intervalo entre a primeira e a segunda dose, iniciando o preparo no dia anterior a realização do exame, foi de 10-12 horas. Resultados: a análise estatística revelou que existe tendência de que os preparos sejam melhores com a associação do bisacodil e que os preparos com lactulose e bisacodil foram mais eficazes. Os preparos com macrogol não foram influenciados pela associação com o bisacodil. Conclusão: nossos resultados permitiram concluir que preparos com lactulose têm maior eficácia quando associados com o bisacodil e naqueles com macrogol, o bisacodil não teve influência(AU)

Preparo de cólon para colonoscopia: estudo comparativo de macrogol e lactulose com e sem bisacodil

Introdução: a colonoscopia é hoje o exame padrão ouro para avaliação das doenças colorretais. O preparo deve ser escolhido de acordo com sua eficácia, tolerabilidade e segurança na administração. A maioria dos serviços indica o preparo anterógrado, por via oral, cujos laxativos têm ação rápida e de curta duração. Pode-se associar o bisacodil, substância com ação catártica a base de difenilmetano. Todavia, há dúvidas quanto à melhora da eficácia do preparo com a associação desse produto. Objetivo: avaliar o preparo intestinal para colonoscopia comparando lactulose e macrogol, com e sem bisacodil. Método: estudo retrospectivo realizado no HSPM-SP, avaliando 211 colonoscopias com preparos feitos com lactulose e macrogol, com e sem bisacodil, realizadas entre abril e agosto de 2012. Os preparos se iniciaram com dieta sem resíduos na véspera do exame e orientação à grande ingesta hídrica. As doses utilizadas foram: GRUPO I - bisacodil, 4 drágeas (20mg) associadas a 120ml de lactulose dissolvidos em 1000ml de suco ou água; GRUPO II - lacutulose, 240ml divididos em duas tomadas de 120ml diluídos em 1000ml de suco ou água; GRUPO III - bisacodil, 4 drágeas (20mg) associadas a macrogol, 8 envelopes dissolvidos em 1000ml de suco ou água; GRUPO IV - macrogol, 16 envelopes divididos em duas tomadas de 8 envelopes dissolvidos em 1000ml de suco ou água. O intervalo entre a primeira e a segunda dose, iniciando o preparo no dia anterior a realização do exame, foi de 10-12 horas. Resultados: a análise estatística revelou que existe tendência de que os preparos sejam melhores com a associação do bisacodil e que os preparos com lactulose e bisacodil foram mais eficazes. Os preparos com macrogol não foram influenciados pela associação com o bisacodil. Conclusão: nossos resultados permitiram concluir que preparos com lactulose têm maior eficácia quando associados com o bisacodil e naqueles com macrogol, o bisacodil não teve influência

Diferentes vias de administração da solução de fosfato monobásico e dibásico de sódio no preparo do cólon para colonoscopia rígida em cães / Different routes in administration of sodium phosphate monobasic and dibasic solution in bowel preparation for rigid colonoscopy in dogs

Foram comparadas duas vias de administração, oral e retal, com a solução de fosfato monobásico e dibásico de sódio (NaP), juntamente com bisacodil via oral, no preparo do cólon para colonoscopia rígida em cães, para avaliar parâmetros clínicos, qualidade do preparo e variações dos eletrólitos fósforo, cálcio, potássio (K+) sódio (Na+) e magnésio (Mg+), além da creatinina, albumina e hemograma. Todos os eletrólitos apresentaram alterações, sendo significativa a queda nos níveis de K+ e Mg+. Não houve alterações eletrocardiográficas, e a redução da microbiota bacteriana foi confirmada nos dois grupos de administração da solução. Os resultados foram similares quanto à incidência de efeitos colaterais, porém a via retal apresentou facilidade na administração, menor retenção fecal no cólon, maior rapidez para realização da colonoscopia, com menor desperdício de tempo na lavagem e na aspiração do conteúdo fecal. O preparo intestinal com bisacodil oral e solução de NaP por via retal foi mais eficaz, podendo ser recomendado em cães que serão submetidos à colonoscopia.(AU)

The efficacy of oral and rectal administration of sodium phosphate monobasic and dibasic solution (NaP) combined with bisacodil per oral, as drugs to prepare the colon for rigid colonoscopy in dogs was compa1ed. Clinical parameters; colonic cleaning, plasma concentration of calcium, potassium (K+), sodium (Na+), magnesium (Mg+), creatinine, and albumin, and complete blood count were evaluated. In both groups, all electrolytes presented alterations, with significant reduction of the levels of K+ and Mg+, but there were no electrocardiographic alterations. No difference in the reduction of bacterial population was observed between the two groups. The results were similar regarding the incidence of side effects; however, the rectal route presented less fecal retention in colon and could get patients ready for the procedure faster. The preparation of bowel with bisacodil and NaP solution by rectal route was more effective and could be recommended for colonoscopy in dogs.(AU)

Avaliação clínica da eficácia e segurança da associação de docusato sódico e bisacodil* comparado com bisacodil** no tratamento de constipações intestinais / The efficacy and safety of the association of docusate sodium compared to bisacodyl in the treatment of constipation

O presente estudo comparou dois medicamentos, consagrados no mercado, utilizados no tratamento da constipação intestinal. São eles: docusato sódico + bisacodil (Humectol D) e bisacodil (Dulcolax). O número de pacientes avaliados foi de 91. A demografia da população do estudo foi dominantemente homogênea para os dois grupos de medicamentos, apesar de alguns dados, como idade e sexo, apresentarem uma distribuição distinta. Os resultados referentes à tolerabilidade foram de bons a excelentes em ambos os grupos de tratamento. Com relação à eficácia dos medicamentos, o docusato sódico + bisacodil (Humectol D) e o bisacodil (Dulcolax) demonstraram-se equivalentes no tratamento de constipações intestinais. Diante dos resultados obtidos nesse estudo clínico ficaram demonstradas a excelente eficácia e tolerabilidade do docusato sódico + bisacodil (Humectol D).

Preparo intestinal para colonoscopia com bisacodil oral e soluçäo fosfatada por via retal em crianças e adolescentes / Intestinal preparation for colonoscopy with oral bisacodyl and phosphate enema in children and adolecents

Näo há um preparo intestinal uniforme para a realizaçäo da colonoscopia que seja recomendado para as diversas faixas etárias da criança, do lactente ao adolescente. Ao contrário do paciente adulto, o procedimento é geralmente realizado com anestesia geral ou sedaçäo profunda. Assim, o jejum oral necessário após a ingestäo do laxante retarda o início do exame. Os autores avaliaram a eficácia de preparo com bisacodil eenema fosfatado em estudo aberto e prospectivo em 17 crianças e adolescentes de ambos os sexos durante um período de 3 meses. A idade dos pacientes variou de 10 meses a 15 anos e 11 meses (mediana =5 anos e 2 meses), sendo 53 por sento do sexo masculino e 47 porcento do feminino. Foi utilizado bisacodil 5mg ou 10mg durante dois dias anteriores ao exame associado a 64ml ou 128ml de soluçäo fosfatada por via retal no diado exame em crianças menores e maiores de 5 anos, respectivamente. preparo excelente foi observado em 53 por cento, bom em 29 por cento e ruim em 18 por cento. Os dados sugerem que o preparo foi mais eficiente em crianças menores de 5 anos. os autores concluem que o preparo foi adequado em 82 por cento dos casos, podendo ser recomendado em crianças menores de 5 anos de idade

Preparo domiciliar de cólon com bisacodil e soluçäo de lactulose a 10 por cento para colonoscopia ambulatorial / Oral bowel preparation with bisacodil and 10 per cent lactulose solution for elective colonoscopy

Realizamos 2000 colonoscopias ambulatoriais de dezembro de 1994 a maio de 1998. Na véspera, o preparo consistiu de dieta sem resíduos e quatro comprimidos de bisacodil às 19 horas. Para a manhä do dia do exame, orientamos o paciente diluir 120ml de lactulose em água ou suco de laranja coado até obter um litro de soluçäo e ingerí-la em uma hora, seis horas antes do início do procedimento endoscópico. Além disso, deveriam beber água ou chá à vontade até o momento do mesmo. As principais indicaçöes foram de dor abdominal, diarréia, enterorragia, obstipaçäo e pesquisa de tumores. Consideramos o resultado como Bom em 84, 85 por cento dos casos, Regular em 9,2 por cento e Ruim em 5,9 por cento. Ocorreu intolerância ao esquema em 3,35 por cento, quando os pacientes referiram vômitos. Queixas de cólicas abdominais, em 9,75 por cento dos casos, ocorreram principalmente durante a noite, sendo creditadas ao bisacodil. Mesmo os doentes com estenose näo complicaram com obstruçäo. Concluímos que o preparo de cólon para colonoscopia com lactose é eficaz, podendo ser feito a nível domiciliar, com boa aceitaçäo e maior conforto para o paciente

Preparo intestinal para cirurgia colorretal eletiva: polietilenoglicol (PEG) X fostato de sódio (FS): Resultados de estudo prospectivo e randomizado / Bowel preparation for elective colorectal surgery: polyethilene glycol (PEG) X sodium phosphate (SP): A prospective randomized trial

A proposta deste estudo foi comparar duas soluçöes orais utilizadas no preparo intestinal mecânico de pacientes submetidos a cirurgia colorretal eletiva. Foram estudados 90 pacientes, prospectivamente randomizados para receber polietilenoglicol (PEG) ou fosfato de sódio (FS). Níveis séricos de hemoglobina, hematócrito, sódio e potássio foram obtidos em todos os pacientes, antes e depois de cada preparo. Todos os efeitos colaterais e complicaçöes pós-operatórias foram relatados. A qualidade do preparo foi avaliada por cirurgiäo "cego" à substância utilizada. As duas soluçöes foram equivalentes no que se refere à limpeza do cólon e à ocorrência de complicaçöes pós-operatórias. No entanto, o FS foi melhor tolerado