Associate Research Scientist, Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th Street, New York, NY 10032, USA.
Therap Adv Gastroenterol. 2013 Jan;6(1):5-14. doi: 10.1177/1756283X12464100.
Rates of suboptimal bowel preparation up to 30% have been reported. Liberalized precolonoscopy diet, split dose purgative, and the use of MiraLAX-based bowel preparation (MBBP) prior to colonoscopy are recently developed measures to improve bowel preparation quality but little is known about the utilization prevalence of these measures. We examined the patterns of utilization of these newer approaches to improve precolonoscopy bowel preparation quality among American gastroenterologists.
Surveys were distributed to a random sample of members of the American College of Gastroenterologists. Participants were queried regarding demographics, practice characteristics, and bowel preparation recommendations including recommendations for liberal dietary restrictions, split dose purgative, and the use of MBBP. Approaches were evaluated individually and in combination.
Of the 999 eligible participants, 288 responded; 15.2% recommended a liberal diet, 60.0% split dose purgative, and 37.4% MBBP. Diet recommendations varied geographically with gastroenterologists in the West more likely to recommend a restrictive diet (odds ratio [OR] 2.98, 95% confidence interval [CI] 1.16-7.67) and physicians in the Northeast more likely to recommend a liberal diet more likely. Older physicians more often recommended split dosing (OR 1.04, 95% CI 1.04-2.97). Use of MBBP was more common in suburban settings (OR 2.14, 95% CI 1.23-3.73). Evidence suggests that physicians in private practice were more likely to prescribe split dosing (p = 0.03) and less often recommended MBBP (p = 0.02). Likelihood of prescribing MBBP increased as weekly volume of colonoscopy increased (p = 0.03).
To enhance bowel preparation quality American gastroenterologists commonly use purgative split dosing. The use of MBBP is becoming more prevalent while a liberalized diet is infrequently recommended. Utilization of these newer approaches to improve bowel preparation quality varies by physician and practice characteristics. Further evaluation of the patterns of usage of these measures is indicated.
据报道，肠道准备不充分的发生率高达 30%。最近，为了提高肠道准备质量，人们采用了放宽结肠镜检查前饮食限制、分剂量泻药和使用米拉拉克（MiraLAX）为基础的肠道准备（MBBP）等措施，但对于这些措施的使用情况知之甚少。我们调查了美国胃肠病学家在提高结肠镜检查前肠道准备质量方面使用这些新方法的模式。
向美国胃肠病学会的随机样本成员发放调查问卷。询问参与者的人口统计学、实践特征以及肠道准备建议，包括对宽松饮食限制、分剂量泻药和使用 MBBP 的建议。分别评估了这些方法的应用，并进行了组合评估。
在 999 名合格的参与者中，有 288 名做出了回应；15.2%的人建议进行宽松饮食，60.0%的人建议使用分剂量泻药，37.4%的人建议使用 MBBP。饮食建议因地理位置而异，西部的胃肠病学家更倾向于推荐限制饮食（优势比[OR]2.98，95%置信区间[CI]1.16-7.67），而东北部的医生更倾向于推荐宽松饮食。年长的医生更倾向于推荐分剂量用药（OR 1.04，95% CI 1.04-2.97）。在郊区环境中，MBBP 的使用更为常见（OR 2.14，95% CI 1.23-3.73）。有证据表明，私人执业的医生更有可能开分剂量用药（p=0.03），而不太可能推荐 MBBP（p=0.02）。随着每周结肠镜检查量的增加，开 MBBP 的可能性也随之增加（p=0.03）。
为了提高肠道准备质量，美国胃肠病学家通常使用泻药分剂量用药。MBBP 的使用越来越普遍，而宽松饮食的建议则很少。为提高肠道准备质量而采用的这些新方法的使用情况因医生和实践特征而异。需要进一步评估这些措施的使用模式。
