Research progress of different methods to improve the taste and adverse reactions of intestinal cleansing agents_West China Medical Journal

Authors：

PAN Jie , MA Mengdi , LIN Zhonghua , WANG Yao ,  SUI Jianqing

Gastrointestinal Medicine Department 2, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong 266001, P. R. China;

Corresponding author：

SUI Jianqing, Email: 563572601@qq.com

Keywords：

Bowel preparation; colonoscopy examination; intestinal cleansing agents; taste

DOI：

10.7507/1002-0179.202304095

Video：

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Abstract Full text Figures/Tables Video References Cited by

Colonoscopy examination is the gold standard for diagnosis and treatment of colon diseases and screening for early cancer. Good quality of bowel preparation, which is also called intestinal cleanliness, is the prerequisite for full visualization of colonic mucosal lesions and their details. In clinic, more intestinal cleansing agents, such as polyethylene glycol and magneium suifate, have bad taste and high dosage, which can not be tolerated by some patients and affect the effect of bowel preparation. The use of oral adjuvant, add adjuvant to intestinal cleansing agents, new low-volume or very low-volume polyethylene glycol-ascorbic acid preparation methods, can reduce the incidence of adverse reactions, such as nausea and vomiting in patients, improve their tolerance, satisfaction and so on. This article reviews the methods of improving the taste and reducing the adverse reactions of intestinal cleansing agents at home and abroad to offer references for clinical practice.

Citation： PAN Jie, MA Mengdi, LIN Zhonghua, WANG Yao, SUI Jianqing. Research progress of different methods to improve the taste and adverse reactions of intestinal cleansing agents. West China Medical Journal, 2024, 39(1): 153-158. doi: 10.7507/1002-0179.202304095 Copy

1.	Migaly J, Bafford AC, Francone TD, et al. The American society of colon and rectal surgeons clinical practice guidelines for the use of bowel preparation in elective colon and rectal surgery. Dis Colon Rectum, 2019, 62(1): 3-8.
2.	中华医学会消化内镜学分会儿科协作组, 中国医师协会内镜医师分会儿科消化内镜专业委员会. 中国儿童消化内镜诊疗相关肠道准备快速指南 (2020, 西安). 中华胃肠内镜电子杂志, 2021, 8(1): 1-12.
3.	Spada C, Cesaro P, Bazzoli F, et al. Evaluation of Clensia^®, a new low-volume PEG bowel preparation in colonoscopy: multicentre randomized controlled trial versus 4L PEG. Dig Liver Dis, 2017, 49(6): 651-656.
4.	张媛媛, 陆绚, 钮美娥, 等. 咀嚼口香糖对结肠镜检查患者服药依从性及不良反应的影响. 护理学杂志, 2017, 32(9): 34-36.
5.	中国医师协会内镜医师分会消化内镜专业委员会, 中国抗癌协会肿瘤内镜专业委员会. 中国消化内镜诊疗相关肠道准备指南 (2019, 上海). 中华消化内镜杂志, 2019, 36(7): 457-469.
6.	谈碧波, 何娜. 不同溶媒口服复方聚乙二醇电解质散对患者结肠镜检查前肠道准备效果的比较研究. 山西医药杂志, 2021, 50(2): 235-237.
7.	李春建, 于静, 吕一鸣, 等. 聚乙二醇中添加辅助制剂改善口感的研究进展. 中华消化杂志, 2022, 42(5): 354-357.
8.	刘蕊, 魏永辉, 张超. LGI 肠内营养素膳食及口服葡萄糖对结肠镜检查肠道准备及低血糖反应的效果. 中国煤炭工业医学杂志, 2018, 21(1): 74-77.
9.	黄映莲, 冯燕, 匡艾华, 等. 口含糖果对结肠镜检查前肠道准备质量的影响. 安徽医药, 2021, 25(8): 1593-1596.
10.	王国庆. 咀嚼口香糖对服用和爽患者肠道准备效果的影响. 护理学报, 2017, 24(7): 49-52.
11.	张秀静, 马利转, 张竹青, 等. 咀嚼口香糖对结肠镜前肠道准备质量影响的研究. 重庆医学, 2018, 47(29): 3813-3815.
12.	Kamran U, Abbasi A, Tahir I, et al. Can adjuncts to bowel preparation for colonoscopy improve patient experience and result in superior bowel cleanliness? A systematic review and meta-analysis. United European Gastroenterol J, 2020, 8(10): 1217-1227.
13.	Choi HS, Shim CS, Kim GW, et al. Orange juice intake reduces patient discomfort and is effective for bowel cleansing with polyethylene glycol during bowel preparation. Dis Colon Rectum, 2014, 57(10): 1220-1227.
14.	Sharara AI, El-Halabi MM, Abou Fadel CG, et al. Sugar-free menthol candy drops improve the palatability and bowel cleansing effect of polyethylene glycol electrolyte solution. Gastrointest Endosc, 2013, 78(6): 886-891.
15.	Sharara AI, Harb AH, Sarkis FS, et al. Split-dose menthol-enhanced PEG vs PEG-ascorbic acid for colonoscopy preparation. World J Gastroenterol, 2015, 21(6): 1938-1944.
16.	中国加速康复外科专家组. 中国加速康复外科围手术期管理专家共识 (2016). 中华外科杂志, 2016, 54(6): 413-418.
17.	Seo HW, Han KH, Kim S, et al. The efficacy and tolerability of sugared polyethylene glycol for colonoscopy. Korean J Gastroenterol, 2013, 61(2): 88-92.
18.	朱木兰, 甄莉, 苏茜, 等. 口服泻药加葡萄糖在胃肠癌病人术前肠道准备中的应用. 护理研究, 2016, 30(2): 228-230.
19.	Altınbas A, Aktas B, Yılmaz B, et al. Adding pineapple juice to a polyethylene glycol-based bowel cleansing regime improved the quality of colon cleaning. Ann Nutr Metab, 2013, 63(1/2): 83-87.
20.	李春燕, 金伟端, 黄泽芳. 和爽添加果味调料在肠道准备中不良反应的效果观察. 中国实用医药, 2010, 5(5): 152-153.
21.	王秀华, 刘荣耀, 陈学芝, 等. 维生素饮料溶解复方聚乙二醇电解质散对结肠镜检查患者服药依从性及不良反应的影响. 齐鲁护理杂志, 2022, 28(7): 155-157.
22.	李谦, 王建荣. 果味补液盐联合硫酸镁用于老年病人结肠镜检查前肠道准备的效果评价. 护理研究, 2018, 32(17): 2704-2709.
23.	Fujiki H, Watanabe T, Sueoka E, et al. Cancer prevention with green tea and its principal constituent, EGCG: from early investigations to current focus on human cancer stem cells. Mol Cells, 2018, 41(2): 73-82.
24.	Ikeda A, Iso H, Yamagishi K, et al. Plasma tea catechins and risk of cardiovascular disease in middle-aged Japanese subjects: the JPHC study. Atherosclerosis, 2018, 277: 90-97.
25.	Nogueira LP, Nogueira Neto JF, Klein MR, et al. Short-term effects of green tea on blood pressure, endothelial function, and metabolic profile in obese Prehypertensive women: a crossover randomized clinical trial. J Am Coll Nutr, 2017, 36(2): 108-115.
26.	Rahman SU, Li Y, Huang Y, et al. Treatment of inflammatory bowel disease via green tea polyphenols: possible application and protective approaches. Inflammopharmacology, 2018, 26(2): 319-330.
27.	Hao Z, Gong L, Shen Q, et al. Effectiveness of concomitant use of green tea and polyethylene glycol in bowel preparation for colonoscopy: a randomized controlled study. BMC Gastroenterology, 2020, 20(1): 150.
28.	刘丹. 比较聚乙二醇与其联合维生素 C 泡腾片用于肠道准备效果. 乌鲁木齐: 新疆医科大学, 2016.
29.	Xie Q, Chen L, Zhao F, et al. A meta-analysis of randomized controlled trials of low-volume polyethylene glycol plus ascorbic acid versus standard-volume polyethylene glycol solution as bowel preparations for colonoseopy. PLoS One, 2014, 9(6): e99092.
30.	Lee SP, Park E, Kim HV, et al. Does 2 l polyethylene glycol plus ascorbic acid increase the risk of renal impairment compared to 4 l polyethylene glycol?. Dig Dis Sic, 2016, 61(11): 3207-3214.
31.	Kamei M, Shibuya T, Takahashi M, et al. Efficacy and acceptability of 1 liter of polyethylene glycol with ascorbic acid vs. 2 liters of polyethylene glycol plus mosapride and sennoside for colonoscopy preparation. Med Sci Monit, 2018, 24: 523-530.
32.	Tajika M, Tanaka T, Ishihara M, et al. Optimal intake of clear liquids during preparation for afternoon colonoscopy with low-volume polyethylene glycol plus ascorbic acid. Endosc Int Open, 2017, 5(6): E416-E423.
33.	Kim B, Lee SD, Han KS, et al. Comparative evaluation of the efficacy of polyethylene glycol with ascorbic acid and an oral sulfate solution in a split method for bowel preparation: a randomized, multicenter phase Ⅲ clinical Trial. Dis Colon Rectum, 2017, 60(4): 426-432.
34.	Kim MS, Park J, Park JH, et al. Does polyethylene glycol (PEG) plus ascorbic acid induce more mucosal injuries than split-dose 4-L PEG during bowel preparation?. Gut Liver, 2016, 10(2): 237-243.
35.	Lee KJ, Park HJ, Kim HS, et al. Electrolyte changes after bowel preparation for colonoscopy: a randomized controlled multicenter trial. World J Gastroenterol, 2015, 21(10): 3041-3048.
36.	Bednarska O, Nyhlin N, Schmidt PT, et al. The effectiveness and tolerability of a very low-volume bowel preparation for colonoscopy compared to low and high-volume polyethylene glycol-solutions in the real-life setting. Diagnostics (Basel), 2022, 12(5): 1155.
37.	Schreiber S, Baumgart DC, Drenth JPH, et al. Colon cleansing efficacy and safety with 1L NER1006 versus sodium picosulfate with magnesium citrate: a randomized phase 3 trial. Endoscopy, 2019, 51(7): 73-84.
38.	Maida M, Sinagra E, Morreale GC, et al. Effectiveness of very low-volume preparation for colonoscopy: a prospective, multicenter observational study. World J Gastroenterol, 2020, 26(16): 1950-1961.
39.	Clayton LB, Tayo B, Halphen M, et al. Novel 1L polyethylene glycol-based bowel preparation (NER1006): proof of concept assessment versus standard 2L polyethylene glycol with ascorbate-a randomized, parallel group, phase 2, colonoscopist-blinded trial. BMC Gastroenterol, 2019, 19(1): 79.
40.	Epstein M, Halonen J, Sharma P. Bowel preparation with 1L polyethylene glycol and ascorbate NER1006 doubles the chance to detect three or more adenomas in overweight or obese males. Endosc Int Open, 2021, 9(9): E1324-E1334.
41.	Bisschops R, Manning J, Clayton LB, et al. Colon cleansing efficacy and safety with 1L NER1006 versus 2L polyethylene glycol+ascorbate: a randomized phase 3 trial. Endoscopy, 2019, 51(1): 60-72.
42.	Cash BD, Moncrief MBC, Epstein MS, et al. Patient experience with NER1006 as a bowel preparation for colonoscopy: a prospective, multicenter US survey. BMC Gastroenterol, 2021, 21(1): 70.
43.	Yuan X, Zhang Z, Xie J, et al. Comparison of 1L adjuvant auxiliary preparations with 2L solely polyethylene glycol plus ascorbic acid regime for bowel cleaning: a meta-analysis of randomized, controlled trials. Biomed Res Int, 2021, 2021: 6638858.

1. Migaly J, Bafford AC, Francone TD, et al. The American society of colon and rectal surgeons clinical practice guidelines for the use of bowel preparation in elective colon and rectal surgery. Dis Colon Rectum, 2019, 62(1): 3-8.
2. 中华医学会消化内镜学分会儿科协作组, 中国医师协会内镜医师分会儿科消化内镜专业委员会. 中国儿童消化内镜诊疗相关肠道准备快速指南 (2020, 西安). 中华胃肠内镜电子杂志, 2021, 8(1): 1-12.
3. Spada C, Cesaro P, Bazzoli F, et al. Evaluation of Clensia^®, a new low-volume PEG bowel preparation in colonoscopy: multicentre randomized controlled trial versus 4L PEG. Dig Liver Dis, 2017, 49(6): 651-656.
4. 张媛媛, 陆绚, 钮美娥, 等. 咀嚼口香糖对结肠镜检查患者服药依从性及不良反应的影响. 护理学杂志, 2017, 32(9): 34-36.
5. 中国医师协会内镜医师分会消化内镜专业委员会, 中国抗癌协会肿瘤内镜专业委员会. 中国消化内镜诊疗相关肠道准备指南 (2019, 上海). 中华消化内镜杂志, 2019, 36(7): 457-469.
6. 谈碧波, 何娜. 不同溶媒口服复方聚乙二醇电解质散对患者结肠镜检查前肠道准备效果的比较研究. 山西医药杂志, 2021, 50(2): 235-237.
7. 李春建, 于静, 吕一鸣, 等. 聚乙二醇中添加辅助制剂改善口感的研究进展. 中华消化杂志, 2022, 42(5): 354-357.
8. 刘蕊, 魏永辉, 张超. LGI 肠内营养素膳食及口服葡萄糖对结肠镜检查肠道准备及低血糖反应的效果. 中国煤炭工业医学杂志, 2018, 21(1): 74-77.
9. 黄映莲, 冯燕, 匡艾华, 等. 口含糖果对结肠镜检查前肠道准备质量的影响. 安徽医药, 2021, 25(8): 1593-1596.
10. 王国庆. 咀嚼口香糖对服用和爽患者肠道准备效果的影响. 护理学报, 2017, 24(7): 49-52.
11. 张秀静, 马利转, 张竹青, 等. 咀嚼口香糖对结肠镜前肠道准备质量影响的研究. 重庆医学, 2018, 47(29): 3813-3815.
12. Kamran U, Abbasi A, Tahir I, et al. Can adjuncts to bowel preparation for colonoscopy improve patient experience and result in superior bowel cleanliness? A systematic review and meta-analysis. United European Gastroenterol J, 2020, 8(10): 1217-1227.
13. Choi HS, Shim CS, Kim GW, et al. Orange juice intake reduces patient discomfort and is effective for bowel cleansing with polyethylene glycol during bowel preparation. Dis Colon Rectum, 2014, 57(10): 1220-1227.
14. Sharara AI, El-Halabi MM, Abou Fadel CG, et al. Sugar-free menthol candy drops improve the palatability and bowel cleansing effect of polyethylene glycol electrolyte solution. Gastrointest Endosc, 2013, 78(6): 886-891.
15. Sharara AI, Harb AH, Sarkis FS, et al. Split-dose menthol-enhanced PEG vs PEG-ascorbic acid for colonoscopy preparation. World J Gastroenterol, 2015, 21(6): 1938-1944.
16. 中国加速康复外科专家组. 中国加速康复外科围手术期管理专家共识 (2016). 中华外科杂志, 2016, 54(6): 413-418.
17. Seo HW, Han KH, Kim S, et al. The efficacy and tolerability of sugared polyethylene glycol for colonoscopy. Korean J Gastroenterol, 2013, 61(2): 88-92.
18. 朱木兰, 甄莉, 苏茜, 等. 口服泻药加葡萄糖在胃肠癌病人术前肠道准备中的应用. 护理研究, 2016, 30(2): 228-230.
19. Altınbas A, Aktas B, Yılmaz B, et al. Adding pineapple juice to a polyethylene glycol-based bowel cleansing regime improved the quality of colon cleaning. Ann Nutr Metab, 2013, 63(1/2): 83-87.
20. 李春燕, 金伟端, 黄泽芳. 和爽添加果味调料在肠道准备中不良反应的效果观察. 中国实用医药, 2010, 5(5): 152-153.
21. 王秀华, 刘荣耀, 陈学芝, 等. 维生素饮料溶解复方聚乙二醇电解质散对结肠镜检查患者服药依从性及不良反应的影响. 齐鲁护理杂志, 2022, 28(7): 155-157.
22. 李谦, 王建荣. 果味补液盐联合硫酸镁用于老年病人结肠镜检查前肠道准备的效果评价. 护理研究, 2018, 32(17): 2704-2709.
23. Fujiki H, Watanabe T, Sueoka E, et al. Cancer prevention with green tea and its principal constituent, EGCG: from early investigations to current focus on human cancer stem cells. Mol Cells, 2018, 41(2): 73-82.
24. Ikeda A, Iso H, Yamagishi K, et al. Plasma tea catechins and risk of cardiovascular disease in middle-aged Japanese subjects: the JPHC study. Atherosclerosis, 2018, 277: 90-97.
25. Nogueira LP, Nogueira Neto JF, Klein MR, et al. Short-term effects of green tea on blood pressure, endothelial function, and metabolic profile in obese Prehypertensive women: a crossover randomized clinical trial. J Am Coll Nutr, 2017, 36(2): 108-115.
26. Rahman SU, Li Y, Huang Y, et al. Treatment of inflammatory bowel disease via green tea polyphenols: possible application and protective approaches. Inflammopharmacology, 2018, 26(2): 319-330.
27. Hao Z, Gong L, Shen Q, et al. Effectiveness of concomitant use of green tea and polyethylene glycol in bowel preparation for colonoscopy: a randomized controlled study. BMC Gastroenterology, 2020, 20(1): 150.
28. 刘丹. 比较聚乙二醇与其联合维生素 C 泡腾片用于肠道准备效果. 乌鲁木齐: 新疆医科大学, 2016.
29. Xie Q, Chen L, Zhao F, et al. A meta-analysis of randomized controlled trials of low-volume polyethylene glycol plus ascorbic acid versus standard-volume polyethylene glycol solution as bowel preparations for colonoseopy. PLoS One, 2014, 9(6): e99092.
30. Lee SP, Park E, Kim HV, et al. Does 2 l polyethylene glycol plus ascorbic acid increase the risk of renal impairment compared to 4 l polyethylene glycol?. Dig Dis Sic, 2016, 61(11): 3207-3214.
31. Kamei M, Shibuya T, Takahashi M, et al. Efficacy and acceptability of 1 liter of polyethylene glycol with ascorbic acid vs. 2 liters of polyethylene glycol plus mosapride and sennoside for colonoscopy preparation. Med Sci Monit, 2018, 24: 523-530.
32. Tajika M, Tanaka T, Ishihara M, et al. Optimal intake of clear liquids during preparation for afternoon colonoscopy with low-volume polyethylene glycol plus ascorbic acid. Endosc Int Open, 2017, 5(6): E416-E423.
33. Kim B, Lee SD, Han KS, et al. Comparative evaluation of the efficacy of polyethylene glycol with ascorbic acid and an oral sulfate solution in a split method for bowel preparation: a randomized, multicenter phase Ⅲ clinical Trial. Dis Colon Rectum, 2017, 60(4): 426-432.
34. Kim MS, Park J, Park JH, et al. Does polyethylene glycol (PEG) plus ascorbic acid induce more mucosal injuries than split-dose 4-L PEG during bowel preparation?. Gut Liver, 2016, 10(2): 237-243.
35. Lee KJ, Park HJ, Kim HS, et al. Electrolyte changes after bowel preparation for colonoscopy: a randomized controlled multicenter trial. World J Gastroenterol, 2015, 21(10): 3041-3048.
36. Bednarska O, Nyhlin N, Schmidt PT, et al. The effectiveness and tolerability of a very low-volume bowel preparation for colonoscopy compared to low and high-volume polyethylene glycol-solutions in the real-life setting. Diagnostics (Basel), 2022, 12(5): 1155.
37. Schreiber S, Baumgart DC, Drenth JPH, et al. Colon cleansing efficacy and safety with 1L NER1006 versus sodium picosulfate with magnesium citrate: a randomized phase 3 trial. Endoscopy, 2019, 51(7): 73-84.
38. Maida M, Sinagra E, Morreale GC, et al. Effectiveness of very low-volume preparation for colonoscopy: a prospective, multicenter observational study. World J Gastroenterol, 2020, 26(16): 1950-1961.
39. Clayton LB, Tayo B, Halphen M, et al. Novel 1L polyethylene glycol-based bowel preparation (NER1006): proof of concept assessment versus standard 2L polyethylene glycol with ascorbate-a randomized, parallel group, phase 2, colonoscopist-blinded trial. BMC Gastroenterol, 2019, 19(1): 79.
40. Epstein M, Halonen J, Sharma P. Bowel preparation with 1L polyethylene glycol and ascorbate NER1006 doubles the chance to detect three or more adenomas in overweight or obese males. Endosc Int Open, 2021, 9(9): E1324-E1334.
41. Bisschops R, Manning J, Clayton LB, et al. Colon cleansing efficacy and safety with 1L NER1006 versus 2L polyethylene glycol+ascorbate: a randomized phase 3 trial. Endoscopy, 2019, 51(1): 60-72.
42. Cash BD, Moncrief MBC, Epstein MS, et al. Patient experience with NER1006 as a bowel preparation for colonoscopy: a prospective, multicenter US survey. BMC Gastroenterol, 2021, 21(1): 70.
43. Yuan X, Zhang Z, Xie J, et al. Comparison of 1L adjuvant auxiliary preparations with 2L solely polyethylene glycol plus ascorbic acid regime for bowel cleaning: a meta-analysis of randomized, controlled trials. Biomed Res Int, 2021, 2021: 6638858.

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Research progress of different methods to improve the taste and adverse reactions of intestinal cleansing agents

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