Higashimori Akira, Maeda Natsumi, Nakatani Masami, Yamamoto Ikki, Yanagida Takeshi, Kin Daiyu, Matsumoto Yuji, Morimoto Kenichi, Sasaki Eiji, Fukuda Takashi, Arakawa Tetsuo, Fujiwara Yasuhiro
Department of Gastroenterology, Minami Osaka Hospital, Osaka, Japan.
Department of Gastroenterology, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-Ku, Osaka, 545-8585, Japan.
Dig Dis Sci. 2023 Nov;68(11):4148-4155. doi: 10.1007/s10620-023-08089-8. Epub 2023 Sep 15.
Inadequate bowel preparation (BP) negatively affects the efficacy and quality of colonoscopy. Although constipation has already been reported as one of the most important predictors of inadequate BP, there is limited information on the relation between inadequate BP and bowel habits including constipation-related symptoms, medications, and severity of constipation.
This single-center, prospective observational study was conducted between August 2019 and May 2020. All participants answered questionnaires regarding personal bowel habits and received low-volume polyethylene glycol plus ascorbic acid for outpatient colonoscopy. Severity of constipation was evaluated by constipation scoring system. Bowel preparation cleansing was evaluated using Boston Bowel Preparation Scale (BBPS). Potential predictors of inadequate BP were analyzed using multivariate logistic regression models.
Overall, 1054 patients were enrolled, of which, 105 (10%) had inadequate BP (total BBPS ≤ 6 or any segmental BBPS < 2). The risk of inadequate BP increased with constipation severity (P = 0.01). Multivariate analysis showed that frequent straining (> 25% of defecations) (OR 2.09, 95% CI: 1.33-3.28) and chronic use of stimulant laxatives (OR 2.57, 95% CI: 1.59-4.17) were significant predictors of inadequate BP, among personal bowel habits.
Frequent straining and chronic use of stimulant laxatives were predictors of inadequate BP. An intensified preparation regimen should be considered for severely constipated patients with straining and chronic use of stimulant laxatives.
肠道准备不充分（BP）会对结肠镜检查的效果和质量产生负面影响。尽管便秘已被报道为肠道准备不充分的最重要预测因素之一，但关于肠道准备不充分与包括便秘相关症状、药物及便秘严重程度在内的排便习惯之间的关系，相关信息有限。
本单中心前瞻性观察性研究于2019年8月至2020年5月进行。所有参与者均回答了关于个人排便习惯的问卷，并接受低容量聚乙二醇加抗坏血酸用于门诊结肠镜检查。采用便秘评分系统评估便秘的严重程度。使用波士顿肠道准备量表（BBPS）评估肠道准备清洁情况。采用多因素逻辑回归模型分析肠道准备不充分的潜在预测因素。
总体而言，共纳入1054例患者，其中105例（10%）肠道准备不充分（总BBPS≤6或任何节段性BBPS<2）。肠道准备不充分的风险随便秘严重程度增加而升高（P = 0.01）。多因素分析显示，在个人排便习惯中，频繁用力排便（>25%的排便次数）（比值比2.09，95%置信区间：1.33 - 3.28）和长期使用刺激性泻药（比值比2.57，95%置信区间：1.59 - 4.17）是肠道准备不充分的显著预测因素。
频繁用力排便和长期使用刺激性泻药是肠道准备不充分的预测因素。对于有用力排便和长期使用刺激性泻药的严重便秘患者，应考虑强化准备方案。
