Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Department of Gastroenterology, Faculty of Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan.
PLoS One. 2023 Aug 17;18(8):e0290329. doi: 10.1371/journal.pone.0290329. eCollection 2023.
Colonoscopy is necessary for diagnosing and surveilling patients with ulcerative colitis, though it may cause disease flares. Colonoscopy with carbon dioxide (CO2) insufflation decreases abdominal discomfort; however, its effect on exacerbation incidence in ulcerative colitis remains unclear. Therefore, this study aimed to evaluate the colonoscopy effects using CO2 insufflation in patients with ulcerative colitis.
Overall, 96 remissive patients with ulcerative colitis (partial Mayo score ≤ 2) who underwent total colonoscopy between March 2015 and December 2019 at Osaka University Hospital were enrolled and blindly randomized to the CO2 (n = 45) and air (n = 51) insufflation group (UMIN-CTR, number: UMIN000018801). The post-procedural abdominal discomfort and the clinical relapse (partial Mayo score ≥ 3) rate within 8 weeks were evaluated.
Baseline backgrounds did not differ between the groups. The mean abdominal fullness and pain scores were significantly lower in the CO2 group than in the Air group immediately (p = 0.0003, p = 0.0003) and 30 min (p < 0.0001, p < 0.0001) after colonoscopy. While the overall clinical relapse rate remained unchanged between the groups, the clinical relapse rate at 8 weeks after colonoscopy was significantly lower in the CO2 group than in the Air group in patients not in complete remission (Mayo endoscopic subscore ≥ 1, p = 0.049; or partial Mayo score ≥ 1, p = 0.022).
CO2 insufflation can reduce abdominal discomfort in remissive patients with ulcerative colitis and decrease clinical relapse at 8 weeks after colonoscopy for those not in complete remission.
结肠镜检查对于溃疡性结肠炎患者的诊断和监测是必要的，但可能会导致疾病发作。二氧化碳（CO2）注入的结肠镜检查可以减轻腹部不适；然而，其对溃疡性结肠炎发作发生率的影响尚不清楚。因此，本研究旨在评估溃疡性结肠炎患者使用 CO2 注入进行结肠镜检查的效果。
共有 96 例缓解期溃疡性结肠炎（部分 Mayo 评分≤2）患者在 2015 年 3 月至 2019 年 12 月期间在大阪大学医院接受了全结肠镜检查，这些患者被纳入并盲法随机分为 CO2（n=45）和空气（n=51）注入组（UMIN-CTR，编号：UMIN000018801）。评估术后 8 周内的腹部不适和临床复发（部分 Mayo 评分≥3）发生率。
两组患者的基线背景无差异。CO2 组的腹部饱胀和疼痛评分在结肠镜检查后即刻（p=0.0003，p=0.0003）和 30 分钟（p<0.0001，p<0.0001）时明显低于空气组。虽然两组患者的总体临床复发率保持不变，但在未完全缓解的患者（Mayo 内镜亚评分≥1，p=0.049；或部分 Mayo 评分≥1，p=0.022）中，CO2 组在结肠镜检查后 8 周时的临床复发率明显低于空气组。
CO2 注入可以减轻缓解期溃疡性结肠炎患者的腹部不适，并降低未完全缓解患者结肠镜检查后 8 周的临床复发率。
