Research progress of different methods to improve the taste and adverse reactions of intestinal cleansing agents_West China Medical Journal

Authors：

PAN Jie , MA Mengdi , LIN Zhonghua , WANG Yao ,  SUI Jianqing

Gastrointestinal Medicine Department 2, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong 266001, P. R. China;

Corresponding?author：

SUI Jianqing, Email: 563572601@qq.com

Keywords：

Bowel preparation; colonoscopy examination; intestinal cleansing agents; taste

DOI：

10.7507/1002-0179.202304095

Video：

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Abstract Full text Figures/Tables Video References Cited by

Colonoscopy examination is the gold standard for diagnosis and treatment of colon diseases and screening for early cancer. Good quality of bowel preparation, which is also called intestinal cleanliness, is the prerequisite for full visualization of colonic mucosal lesions and their details. In clinic, more intestinal cleansing agents, such as polyethylene glycol and magneium suifate, have bad taste and high dosage, which can not be tolerated by some patients and affect the effect of bowel preparation. The use of oral adjuvant, add adjuvant to intestinal cleansing agents, new low-volume or very low-volume polyethylene glycol-ascorbic acid preparation methods, can reduce the incidence of adverse reactions, such as nausea and vomiting in patients, improve their tolerance, satisfaction and so on. This article reviews the methods of improving the taste and reducing the adverse reactions of intestinal cleansing agents at home and abroad to offer references for clinical practice.

Citation： PAN Jie, MA Mengdi, LIN Zhonghua, WANG Yao, SUI Jianqing. Research progress of different methods to improve the taste and adverse reactions of intestinal cleansing agents. West China Medical Journal, 2024, 39(1): 153-158. doi: 10.7507/1002-0179.202304095 Copy

1.	Migaly J, Bafford AC, Francone TD, et al. The American society of colon and rectal surgeons clinical practice guidelines for the use of bowel preparation in elective colon and rectal surgery. Dis Colon Rectum, 2019, 62(1): 3-8.
2.	中華醫學會消化內鏡學分會兒科協作組, 中國醫師協會內鏡醫師分會兒科消化內鏡專業委員會. 中國兒童消化內鏡診療相關腸道準備快速指南 (2020, 西安). 中華胃腸內鏡電子雜志, 2021, 8(1): 1-12.
3.	Spada C, Cesaro P, Bazzoli F, et al. Evaluation of Clensia^?, a new low-volume PEG bowel preparation in colonoscopy: multicentre randomized controlled trial versus 4L PEG. Dig Liver Dis, 2017, 49(6): 651-656.
4.	張媛媛, 陸絢, 鈕美娥, 等. 咀嚼口香糖對結腸鏡檢查患者服藥依從性及不良反應的影響. 護理學雜志, 2017, 32(9): 34-36.
5.	中國醫師協會內鏡醫師分會消化內鏡專業委員會, 中國抗癌協會腫瘤內鏡專業委員會. 中國消化內鏡診療相關腸道準備指南 (2019, 上海). 中華消化內鏡雜志, 2019, 36(7): 457-469.
6.	談碧波, 何娜. 不同溶媒口服復方聚乙二醇電解質散對患者結腸鏡檢查前腸道準備效果的比較研究. 山西醫藥雜志, 2021, 50(2): 235-237.
7.	李春建, 于靜, 呂一鳴, 等. 聚乙二醇中添加輔助制劑改善口感的研究進展. 中華消化雜志, 2022, 42(5): 354-357.
8.	劉蕊, 魏永輝, 張超. LGI 腸內營養素膳食及口服葡萄糖對結腸鏡檢查腸道準備及低血糖反應的效果. 中國煤炭工業醫學雜志, 2018, 21(1): 74-77.
9.	黃映蓮, 馮燕, 匡艾華, 等. 口含糖果對結腸鏡檢查前腸道準備質量的影響. 安徽醫藥, 2021, 25(8): 1593-1596.
10.	王國慶. 咀嚼口香糖對服用和爽患者腸道準備效果的影響. 護理學報, 2017, 24(7): 49-52.
11.	張秀靜, 馬利轉, 張竹青, 等. 咀嚼口香糖對結腸鏡前腸道準備質量影響的研究. 重慶醫學, 2018, 47(29): 3813-3815.
12.	Kamran U, Abbasi A, Tahir I, et al. Can adjuncts to bowel preparation for colonoscopy improve patient experience and result in superior bowel cleanliness? A systematic review and meta-analysis. United European Gastroenterol J, 2020, 8(10): 1217-1227.
13.	Choi HS, Shim CS, Kim GW, et al. Orange juice intake reduces patient discomfort and is effective for bowel cleansing with polyethylene glycol during bowel preparation. Dis Colon Rectum, 2014, 57(10): 1220-1227.
14.	Sharara AI, El-Halabi MM, Abou Fadel CG, et al. Sugar-free menthol candy drops improve the palatability and bowel cleansing effect of polyethylene glycol electrolyte solution. Gastrointest Endosc, 2013, 78(6): 886-891.
15.	Sharara AI, Harb AH, Sarkis FS, et al. Split-dose menthol-enhanced PEG vs PEG-ascorbic acid for colonoscopy preparation. World J Gastroenterol, 2015, 21(6): 1938-1944.
16.	中國加速康復外科專家組. 中國加速康復外科圍手術期管理專家共識 (2016). 中華外科雜志, 2016, 54(6): 413-418.
17.	Seo HW, Han KH, Kim S, et al. The efficacy and tolerability of sugared polyethylene glycol for colonoscopy. Korean J Gastroenterol, 2013, 61(2): 88-92.
18.	朱木蘭, 甄莉, 蘇茜, 等. 口服瀉藥加葡萄糖在胃腸癌病人術前腸道準備中的應用. 護理研究, 2016, 30(2): 228-230.
19.	Alt?nbas A, Aktas B, Y?lmaz B, et al. Adding pineapple juice to a polyethylene glycol-based bowel cleansing regime improved the quality of colon cleaning. Ann Nutr Metab, 2013, 63(1/2): 83-87.
20.	李春燕, 金偉端, 黃澤芳. 和爽添加果味調料在腸道準備中不良反應的效果觀察. 中國實用醫藥, 2010, 5(5): 152-153.
21.	王秀華, 劉榮耀, 陳學芝, 等. 維生素飲料溶解復方聚乙二醇電解質散對結腸鏡檢查患者服藥依從性及不良反應的影響. 齊魯護理雜志, 2022, 28(7): 155-157.
22.	李謙, 王建榮. 果味補液鹽聯合硫酸鎂用于老年病人結腸鏡檢查前腸道準備的效果評價. 護理研究, 2018, 32(17): 2704-2709.
23.	Fujiki H, Watanabe T, Sueoka E, et al. Cancer prevention with green tea and its principal constituent, EGCG: from early investigations to current focus on human cancer stem cells. Mol Cells, 2018, 41(2): 73-82.
24.	Ikeda A, Iso H, Yamagishi K, et al. Plasma tea catechins and risk of cardiovascular disease in middle-aged Japanese subjects: the JPHC study. Atherosclerosis, 2018, 277: 90-97.
25.	Nogueira LP, Nogueira Neto JF, Klein MR, et al. Short-term effects of green tea on blood pressure, endothelial function, and metabolic profile in obese Prehypertensive women: a crossover randomized clinical trial. J Am Coll Nutr, 2017, 36(2): 108-115.
26.	Rahman SU, Li Y, Huang Y, et al. Treatment of inflammatory bowel disease via green tea polyphenols: possible application and protective approaches. Inflammopharmacology, 2018, 26(2): 319-330.
27.	Hao Z, Gong L, Shen Q, et al. Effectiveness of concomitant use of green tea and polyethylene glycol in bowel preparation for colonoscopy: a randomized controlled study. BMC Gastroenterology, 2020, 20(1): 150.
28.	劉丹. 比較聚乙二醇與其聯合維生素 C 泡騰片用于腸道準備效果. 烏魯木齊: 新疆醫科大學, 2016.
29.	Xie Q, Chen L, Zhao F, et al. A meta-analysis of randomized controlled trials of low-volume polyethylene glycol plus ascorbic acid versus standard-volume polyethylene glycol solution as bowel preparations for colonoseopy. PLoS One, 2014, 9(6): e99092.
30.	Lee SP, Park E, Kim HV, et al. Does 2 l polyethylene glycol plus ascorbic acid increase the risk of renal impairment compared to 4 l polyethylene glycol?. Dig Dis Sic, 2016, 61(11): 3207-3214.
31.	Kamei M, Shibuya T, Takahashi M, et al. Efficacy and acceptability of 1 liter of polyethylene glycol with ascorbic acid vs. 2 liters of polyethylene glycol plus mosapride and sennoside for colonoscopy preparation. Med Sci Monit, 2018, 24: 523-530.
32.	Tajika M, Tanaka T, Ishihara M, et al. Optimal intake of clear liquids during preparation for afternoon colonoscopy with low-volume polyethylene glycol plus ascorbic acid. Endosc Int Open, 2017, 5(6): E416-E423.
33.	Kim B, Lee SD, Han KS, et al. Comparative evaluation of the efficacy of polyethylene glycol with ascorbic acid and an oral sulfate solution in a split method for bowel preparation: a randomized, multicenter phase Ⅲ clinical Trial. Dis Colon Rectum, 2017, 60(4): 426-432.
34.	Kim MS, Park J, Park JH, et al. Does polyethylene glycol (PEG) plus ascorbic acid induce more mucosal injuries than split-dose 4-L PEG during bowel preparation?. Gut Liver, 2016, 10(2): 237-243.
35.	Lee KJ, Park HJ, Kim HS, et al. Electrolyte changes after bowel preparation for colonoscopy: a randomized controlled multicenter trial. World J Gastroenterol, 2015, 21(10): 3041-3048.
36.	Bednarska O, Nyhlin N, Schmidt PT, et al. The effectiveness and tolerability of a very low-volume bowel preparation for colonoscopy compared to low and high-volume polyethylene glycol-solutions in the real-life setting. Diagnostics (Basel), 2022, 12(5): 1155.
37.	Schreiber S, Baumgart DC, Drenth JPH, et al. Colon cleansing efficacy and safety with 1L NER1006 versus sodium picosulfate with magnesium citrate: a randomized phase 3 trial. Endoscopy, 2019, 51(7): 73-84.
38.	Maida M, Sinagra E, Morreale GC, et al. Effectiveness of very low-volume preparation for colonoscopy: a prospective, multicenter observational study. World J Gastroenterol, 2020, 26(16): 1950-1961.
39.	Clayton LB, Tayo B, Halphen M, et al. Novel 1L polyethylene glycol-based bowel preparation (NER1006): proof of concept assessment versus standard 2L polyethylene glycol with ascorbate-a randomized, parallel group, phase 2, colonoscopist-blinded trial. BMC Gastroenterol, 2019, 19(1): 79.
40.	Epstein M, Halonen J, Sharma P. Bowel preparation with 1L polyethylene glycol and ascorbate NER1006 doubles the chance to detect three or more adenomas in overweight or obese males. Endosc Int Open, 2021, 9(9): E1324-E1334.
41.	Bisschops R, Manning J, Clayton LB, et al. Colon cleansing efficacy and safety with 1L NER1006 versus 2L polyethylene glycol+ascorbate: a randomized phase 3 trial. Endoscopy, 2019, 51(1): 60-72.
42.	Cash BD, Moncrief MBC, Epstein MS, et al. Patient experience with NER1006 as a bowel preparation for colonoscopy: a prospective, multicenter US survey. BMC Gastroenterol, 2021, 21(1): 70.
43.	Yuan X, Zhang Z, Xie J, et al. Comparison of 1L adjuvant auxiliary preparations with 2L solely polyethylene glycol plus ascorbic acid regime for bowel cleaning: a meta-analysis of randomized, controlled trials. Biomed Res Int, 2021, 2021: 6638858.

1. Migaly J, Bafford AC, Francone TD, et al. The American society of colon and rectal surgeons clinical practice guidelines for the use of bowel preparation in elective colon and rectal surgery. Dis Colon Rectum, 2019, 62(1): 3-8.
2. 中華醫學會消化內鏡學分會兒科協作組, 中國醫師協會內鏡醫師分會兒科消化內鏡專業委員會. 中國兒童消化內鏡診療相關腸道準備快速指南 (2020, 西安). 中華胃腸內鏡電子雜志, 2021, 8(1): 1-12.
3. Spada C, Cesaro P, Bazzoli F, et al. Evaluation of Clensia^?, a new low-volume PEG bowel preparation in colonoscopy: multicentre randomized controlled trial versus 4L PEG. Dig Liver Dis, 2017, 49(6): 651-656.
4. 張媛媛, 陸絢, 鈕美娥, 等. 咀嚼口香糖對結腸鏡檢查患者服藥依從性及不良反應的影響. 護理學雜志, 2017, 32(9): 34-36.
5. 中國醫師協會內鏡醫師分會消化內鏡專業委員會, 中國抗癌協會腫瘤內鏡專業委員會. 中國消化內鏡診療相關腸道準備指南 (2019, 上海). 中華消化內鏡雜志, 2019, 36(7): 457-469.
6. 談碧波, 何娜. 不同溶媒口服復方聚乙二醇電解質散對患者結腸鏡檢查前腸道準備效果的比較研究. 山西醫藥雜志, 2021, 50(2): 235-237.
7. 李春建, 于靜, 呂一鳴, 等. 聚乙二醇中添加輔助制劑改善口感的研究進展. 中華消化雜志, 2022, 42(5): 354-357.
8. 劉蕊, 魏永輝, 張超. LGI 腸內營養素膳食及口服葡萄糖對結腸鏡檢查腸道準備及低血糖反應的效果. 中國煤炭工業醫學雜志, 2018, 21(1): 74-77.
9. 黃映蓮, 馮燕, 匡艾華, 等. 口含糖果對結腸鏡檢查前腸道準備質量的影響. 安徽醫藥, 2021, 25(8): 1593-1596.
10. 王國慶. 咀嚼口香糖對服用和爽患者腸道準備效果的影響. 護理學報, 2017, 24(7): 49-52.
11. 張秀靜, 馬利轉, 張竹青, 等. 咀嚼口香糖對結腸鏡前腸道準備質量影響的研究. 重慶醫學, 2018, 47(29): 3813-3815.
12. Kamran U, Abbasi A, Tahir I, et al. Can adjuncts to bowel preparation for colonoscopy improve patient experience and result in superior bowel cleanliness? A systematic review and meta-analysis. United European Gastroenterol J, 2020, 8(10): 1217-1227.
13. Choi HS, Shim CS, Kim GW, et al. Orange juice intake reduces patient discomfort and is effective for bowel cleansing with polyethylene glycol during bowel preparation. Dis Colon Rectum, 2014, 57(10): 1220-1227.
14. Sharara AI, El-Halabi MM, Abou Fadel CG, et al. Sugar-free menthol candy drops improve the palatability and bowel cleansing effect of polyethylene glycol electrolyte solution. Gastrointest Endosc, 2013, 78(6): 886-891.
15. Sharara AI, Harb AH, Sarkis FS, et al. Split-dose menthol-enhanced PEG vs PEG-ascorbic acid for colonoscopy preparation. World J Gastroenterol, 2015, 21(6): 1938-1944.
16. 中國加速康復外科專家組. 中國加速康復外科圍手術期管理專家共識 (2016). 中華外科雜志, 2016, 54(6): 413-418.
17. Seo HW, Han KH, Kim S, et al. The efficacy and tolerability of sugared polyethylene glycol for colonoscopy. Korean J Gastroenterol, 2013, 61(2): 88-92.
18. 朱木蘭, 甄莉, 蘇茜, 等. 口服瀉藥加葡萄糖在胃腸癌病人術前腸道準備中的應用. 護理研究, 2016, 30(2): 228-230.
19. Alt?nbas A, Aktas B, Y?lmaz B, et al. Adding pineapple juice to a polyethylene glycol-based bowel cleansing regime improved the quality of colon cleaning. Ann Nutr Metab, 2013, 63(1/2): 83-87.
20. 李春燕, 金偉端, 黃澤芳. 和爽添加果味調料在腸道準備中不良反應的效果觀察. 中國實用醫藥, 2010, 5(5): 152-153.
21. 王秀華, 劉榮耀, 陳學芝, 等. 維生素飲料溶解復方聚乙二醇電解質散對結腸鏡檢查患者服藥依從性及不良反應的影響. 齊魯護理雜志, 2022, 28(7): 155-157.
22. 李謙, 王建榮. 果味補液鹽聯合硫酸鎂用于老年病人結腸鏡檢查前腸道準備的效果評價. 護理研究, 2018, 32(17): 2704-2709.
23. Fujiki H, Watanabe T, Sueoka E, et al. Cancer prevention with green tea and its principal constituent, EGCG: from early investigations to current focus on human cancer stem cells. Mol Cells, 2018, 41(2): 73-82.
24. Ikeda A, Iso H, Yamagishi K, et al. Plasma tea catechins and risk of cardiovascular disease in middle-aged Japanese subjects: the JPHC study. Atherosclerosis, 2018, 277: 90-97.
25. Nogueira LP, Nogueira Neto JF, Klein MR, et al. Short-term effects of green tea on blood pressure, endothelial function, and metabolic profile in obese Prehypertensive women: a crossover randomized clinical trial. J Am Coll Nutr, 2017, 36(2): 108-115.
26. Rahman SU, Li Y, Huang Y, et al. Treatment of inflammatory bowel disease via green tea polyphenols: possible application and protective approaches. Inflammopharmacology, 2018, 26(2): 319-330.
27. Hao Z, Gong L, Shen Q, et al. Effectiveness of concomitant use of green tea and polyethylene glycol in bowel preparation for colonoscopy: a randomized controlled study. BMC Gastroenterology, 2020, 20(1): 150.
28. 劉丹. 比較聚乙二醇與其聯合維生素 C 泡騰片用于腸道準備效果. 烏魯木齊: 新疆醫科大學, 2016.
29. Xie Q, Chen L, Zhao F, et al. A meta-analysis of randomized controlled trials of low-volume polyethylene glycol plus ascorbic acid versus standard-volume polyethylene glycol solution as bowel preparations for colonoseopy. PLoS One, 2014, 9(6): e99092.
30. Lee SP, Park E, Kim HV, et al. Does 2 l polyethylene glycol plus ascorbic acid increase the risk of renal impairment compared to 4 l polyethylene glycol?. Dig Dis Sic, 2016, 61(11): 3207-3214.
31. Kamei M, Shibuya T, Takahashi M, et al. Efficacy and acceptability of 1 liter of polyethylene glycol with ascorbic acid vs. 2 liters of polyethylene glycol plus mosapride and sennoside for colonoscopy preparation. Med Sci Monit, 2018, 24: 523-530.
32. Tajika M, Tanaka T, Ishihara M, et al. Optimal intake of clear liquids during preparation for afternoon colonoscopy with low-volume polyethylene glycol plus ascorbic acid. Endosc Int Open, 2017, 5(6): E416-E423.
33. Kim B, Lee SD, Han KS, et al. Comparative evaluation of the efficacy of polyethylene glycol with ascorbic acid and an oral sulfate solution in a split method for bowel preparation: a randomized, multicenter phase Ⅲ clinical Trial. Dis Colon Rectum, 2017, 60(4): 426-432.
34. Kim MS, Park J, Park JH, et al. Does polyethylene glycol (PEG) plus ascorbic acid induce more mucosal injuries than split-dose 4-L PEG during bowel preparation?. Gut Liver, 2016, 10(2): 237-243.
35. Lee KJ, Park HJ, Kim HS, et al. Electrolyte changes after bowel preparation for colonoscopy: a randomized controlled multicenter trial. World J Gastroenterol, 2015, 21(10): 3041-3048.
36. Bednarska O, Nyhlin N, Schmidt PT, et al. The effectiveness and tolerability of a very low-volume bowel preparation for colonoscopy compared to low and high-volume polyethylene glycol-solutions in the real-life setting. Diagnostics (Basel), 2022, 12(5): 1155.
37. Schreiber S, Baumgart DC, Drenth JPH, et al. Colon cleansing efficacy and safety with 1L NER1006 versus sodium picosulfate with magnesium citrate: a randomized phase 3 trial. Endoscopy, 2019, 51(7): 73-84.
38. Maida M, Sinagra E, Morreale GC, et al. Effectiveness of very low-volume preparation for colonoscopy: a prospective, multicenter observational study. World J Gastroenterol, 2020, 26(16): 1950-1961.
39. Clayton LB, Tayo B, Halphen M, et al. Novel 1L polyethylene glycol-based bowel preparation (NER1006): proof of concept assessment versus standard 2L polyethylene glycol with ascorbate-a randomized, parallel group, phase 2, colonoscopist-blinded trial. BMC Gastroenterol, 2019, 19(1): 79.
40. Epstein M, Halonen J, Sharma P. Bowel preparation with 1L polyethylene glycol and ascorbate NER1006 doubles the chance to detect three or more adenomas in overweight or obese males. Endosc Int Open, 2021, 9(9): E1324-E1334.
41. Bisschops R, Manning J, Clayton LB, et al. Colon cleansing efficacy and safety with 1L NER1006 versus 2L polyethylene glycol+ascorbate: a randomized phase 3 trial. Endoscopy, 2019, 51(1): 60-72.
42. Cash BD, Moncrief MBC, Epstein MS, et al. Patient experience with NER1006 as a bowel preparation for colonoscopy: a prospective, multicenter US survey. BMC Gastroenterol, 2021, 21(1): 70.
43. Yuan X, Zhang Z, Xie J, et al. Comparison of 1L adjuvant auxiliary preparations with 2L solely polyethylene glycol plus ascorbic acid regime for bowel cleaning: a meta-analysis of randomized, controlled trials. Biomed Res Int, 2021, 2021: 6638858.

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Research progress of different methods to improve the taste and adverse reactions of intestinal cleansing agents

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