Improving adherence towards bowel preparation for colonoscopy

The most popular regimes today are based on polyethylene glycol (PEG)–electrolyte lavage solution. 5 PEG is a non-absorbable solution that should pass through the bowel without net absorption or secretion. To improve the adherence to PEG solutions, reduced volume (2 L) preparations coupled with irritant laxatives such as bisacodyl or magnesium citrate have been developed to increase patient compliance and are recognized to be as effective as the standard 4 L PEG preparation. 6 An alternative approach has been to split the 4 L PEG dosing to the day before and on the day of the procedure, which has been suggested to reduce adverse gastrointestinal (GI) symptoms and improve adherence. 7 In this issue of JGH OPEN, Yang et al. have reported a randomized trial comparing predominantly 4 L PEG solution and 2 L PEG in combination with Linaclotide as bowel preparation for colonoscopy in 266 patients. 8 There was no difference in bowel preparation quality or colon polyp detection rate between the two groups. Linaclotide, a guanylate cyclase-C (GC-C) agonist, which increases intestinal chloride and fluid secretion by activating the guanosine cyclic phosphate (cGMP) cascade, has been shown to be effective in the treatment of constipation-predominant irritable bowel syndrome (IBS-C) and chronic idiopathic constipation (CIC).