High-Volume Colonic Lavage Is a Safe and Preferred Colonoscopy Preparation for Patients With Inflammatory Bowel Disease.

Background: Colonoscopies provide a crucial diagnostic and surveillance tool for inflammatory bowel disease (IBD). Accordingly, IBD patients undergo repeated and frequent colonoscopies. The oral purgative bowel prep (BP) is often burdensome on patients, resulting in delayed or missed colonoscopies due to patient noncompliance. Additionally, oral BP has been noted to possibly induce colon mucosal inflammatory changes in some patients, which may be misleading when assessing actual disease activity. Methods: In this retrospective clinical study, we evaluated the use of an FDA cleared, defecation-inducing high-volume colon irrigation (>40 L) BP to prepare IBD patients for colonoscopy. Data were collected at 4 US Hygieacare centers from September 2016 to March 2021. The IBD patient population consisted of 314 patients that underwent 343 BPs. The BPs were prescribed by 65 physicians and performed by 16 nurses and technicians. Results: Patient ages were 20-85 years old, 76% females, 24% males, and 97% of the patients were adequately prepared for their colonoscopy (n = 309). Patient satisfaction with the BP was very high, as reflected in postprocedure surveys and open-ended responses text analyses, and there were no serious adverse events. Conclusions: We present data supporting that the defecation-inducing high-volume colon irrigation BP for colonoscopy is safe, effective, and preferred for IBD patients. Using this BP for IBD patients can allow earlier interventions, significantly impacting disease management and future outcomes.

HIV polyarteritis nodosa-like vasculitis presenting as chronic abdominal pain.

Vasculitic syndromes are a rare entity in patients with human immunodeficiency virus (HIV), in the order of <1%. Though the underlying mechanism is thought to involve cell or immune-complex-mediated inflammation, the common finding within the wide spectrum of vasculitides is inflammation of the blood vessel wall. Furthermore, polyarteritis nodosa (PAN)-like vasculitis associated with HIV infection presents differently from classic or idiopathic PAN, thereby making diagnosis difficult for even the most astute clinician. We present the case of a young HIV-infected woman with chronic abdominal pain that went undiagnosed for over 1 year despite an extensive workup until rheumatologic disorders were considered in the differential. Mesenteric angiogram revealed extensive small vessel microaneurysms consistent with PAN-like vasculitis. The patient responded well to corticosteroid therapy and remained symptom-free upon discharge. Despite its relatively low prevalence, vasculitides such as PAN should be considered in patient with unexplained symptoms after thoroughly completing an evaluation for more common diseases, especially considering its good prognosis associated with corticosteroid therapy.