A feasibility study of probiotics pretreatment as a bowel preparation for colonoscopy in constipated patients.
BACKGROUND
The use of probiotics to treat constipation is based on the premise that supplying the gut with healthy bacteria in the form of probiotics can help normalize intestinal function. The aim of this study was to determine the efficacy of a 2-week probiotics pretreatment with oral sodium phosphate (NaP) for bowel cleansing before colonoscopy in patients with constipation.


METHODS
Patients with constipation were prospectively randomized to receive a 2-week probiotics course comprising a mixture of Bacillus subtilis and Streptococcus faecium (group A, n = 51) or placebo (group B, n = 53) with an oral NaP solution. During the same period, another 107 patients with normal bowel movement were enrolled and received the probiotics treatment (n = 53, group C) or placebo (n = 54, group D). The primary outcome measure was the quality of bowel cleansing. Postendoscopic symptoms were estimated using a visual analogue scale.


RESULTS
Patients having normal defecation presented with better bowel preparation than those with constipation (57.9% versus 37.5%; P = 0.003). Probiotics pretreatment (group A) was more effective at bowel cleansing for colonoscopy compared with placebo (group B) in constipated patients (54.9% versus 20.8%; P < 0.001). In contrast, preparation quality did not differ significantly between groups C and D. Preparation-related adverse events and postendoscopic symptoms were more frequent and severe in group B than in group A.


CONCLUSIONS
Two weeks of probiotics pretreatment as part of bowel preparation significantly improves colonic mucosa visualization during colonoscopy and reduces preparation-related and postendoscopic gastrointestinal symptoms in constipated patients.
Lee
Hyuk
H
Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Kim
Young-Ho
YH
Kim
Jeong Hwan
JH
Chang
Dong Kyung
DK
Kim
Jin Yong
JY
Son
Hee Jung
HJ
Rhee
Poong-Lyul
PL
Kim
Jae J
JJ
Rhee
Jong Chul
JC
D000328:Adult; D002400:Cathartics / Q000627:therapeutic use*; D003113:Colonoscopy; D003248:Constipation / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010710:Phosphates / Q000627:therapeutic use; D019936:Probiotics / Q000627:therapeutic use*; D055815:Young Adult
D002400:Cathartics; D010710:Phosphates; C018279:sodium phosphate