Vinod Jeevan, Bonheur Jennifer, Korelitz Burton I, Panagopoulos Georgia
Department of Gastroenterology, Lenox Hill Hospital, and New York University School of Medicine, 100 East 77th Street, New York, NY 10021, 6 Black Hall, New York, USA.
World J Gastroenterol. 2007 Dec 28;13(48):6549-52. doi: 10.3748/wjg.v13.i48.6549.
To elucidate the preferences of gastroenterologists at our institution and compare them to those of obstetricians when making decisions in the pregnant patient, including which type of bowel preparations to use for flexible sigmoidoscopy or colonoscopy, as well as which laxatives can be used safely.
Surveys were mailed to all attending gastroenterologists (n = 53) and obstetricians (n = 99) at our institution. Each survey consisted of the 14 most common laxative or motility agents used in pregnancy and inquired about the physician's prescribing habits in the past as well as their willingness to prescribe each medication in the future. The survey also listed four common bowel preparations used prior to colonoscopy and sigmoidoscopy and asked the physician to rank the order of the preferred agent in each case.
With regard to common laxatives, both gastroenterologists and obstetricians favor the use of Metamucil, Colace, and Citrucel. Both groups appear to refrain from using Fleets Phosphosoda and Castor oil. Of note, obstetricians are less inclined to use PEG solution and Miralax, which is not the case with gastroenterologists. In terms of comparing bowel preparations for colonoscopy, 50% of gastroenterologists prefer to use PEG solution and 50% avoid the use of Fleets Phosphosoda. Obstetricians seem to prefer Fleets Phosphosoda (20%) and tend to avoid the use of PEG solution (26%). With regard to bowel preparation for sigmoidoscopy, both groups prefer Fleets enema the most (51%), while magnesium citrate is used least often (38%).
It is clear that preferences in the use of bowel cleansing preparations between the two groups exist, but there have not been many case controlled human studies in the pregnant patient that give clear cut indications for using one versus another drug. In light of the challenge of performing controlled trials in pregnant women, more extensive surveys should be undertaken to gather a larger amount of data on physician's experiences and individual preferences.
阐明我院胃肠病学家在为孕妇做决策时的偏好，并将其与产科医生的偏好进行比较，这些决策包括在进行乙状结肠镜检查或结肠镜检查时使用哪种肠道准备方法，以及哪些泻药可以安全使用。
向我院所有胃肠病学主治医生（n = 53）和产科医生（n = 99）邮寄调查问卷。每份调查问卷包含14种孕期最常用的泻药或促动力药物，并询问医生过去的开药习惯以及他们未来使用每种药物的意愿。调查问卷还列出了结肠镜检查和乙状结肠镜检查前常用的四种肠道准备方法，并要求医生对每种情况下首选药物的顺序进行排序。
对于常用泻药，胃肠病学家和产科医生都倾向于使用美达施、多库酯钠和西梅纤维素。两组似乎都避免使用磷酸钠灌肠剂和蓖麻油。值得注意的是，产科医生不太倾向于使用聚乙二醇溶液和聚卡波非钙，而胃肠病学家则不然。在比较结肠镜检查的肠道准备方法时，50%的胃肠病学家更喜欢使用聚乙二醇溶液，50%避免使用磷酸钠灌肠剂。产科医生似乎更喜欢磷酸钠灌肠剂（20%），并倾向于避免使用聚乙二醇溶液（26%）。关于乙状结肠镜检查的肠道准备，两组都最喜欢使用磷酸钠灌肠剂（51%），而柠檬酸镁使用最少（38%）。
显然，两组在肠道清洁制剂的使用上存在偏好，但针对孕妇的病例对照人体研究并不多，无法明确给出使用一种药物而非另一种药物的明确指征。鉴于在孕妇中进行对照试验的挑战，应进行更广泛的调查，以收集更多关于医生经验和个人偏好的数据。
