title: A validated bowel-preparation tolerability questionnaire and assessment of three commonly used bowel-cleansing agents.
abstract: OBJECTIVE
  Bowel-cleansing studies are frequently underpowered, poorly designed, and with subjective assessments. Consensus on tolerability of the bowel-cleansing agents is thus lacking. This study developed and validated a bowel-preparation tolerability questionnaire and used it to assess the tolerability of three bowel-cleansing agents, sodium phosphate (NaP), polyethylene glycol (PEG), and sodium picosulphate (Pico), in a prospective randomized single-blinded trial of ambulatory patients.
  
  
  METHODS
  The bowel-preparation tolerability questionnaire was validated in 125 consecutive patients and then bowel-preparation agent tolerability was assessed in 634 patients in a prospective randomized single-blinded trial.
  
  
  RESULTS
  The questionnaire's internal consistency was satisfactory with good to excellent "test-retest" reliability for aggregate tolerability and visual analogue scores. Validity assessment confirmed it as reliable and accurate. Of 634 patients, 97.8 % took >75 % of the allocated preparation and 98.9 % completed the questionnaire. Overall, Pico was better tolerated than PEG (p < 0.001) and NaP (p < 0.001). NaP was better tolerated than PEG (p < 0.001). Regardless of the bowel-preparation agent used, males tolerated them better than females (p = 0.009) as did patients having their procedure in the AM. Older patients, however, tolerated all preparations better than younger patients (p = 0.006).
  
  
  CONCLUSIONS
  This study used the first validated bowel-preparation tolerability questionnaire and identified that age, sex, and procedure time all impacted tolerability. Overall, Pico was best tolerated, but PEG's tolerability in patients ≥60 years was equal to that of Pico and NaP, suggesting that PEG can be recommended for older patients to avoid the electrolyte disturbances associated with the osmotic preparations.
authors.affiliation: Centre for Inflammatory Bowel Diseases, Fremantle Hospital, Fremantle, WA, Australia. ian.lawrance@uwa.edu.au
authors.forename: I C
authors.initials: IC
authors.lastname: Lawrance
authors.forename: R P
authors.initials: RP
authors.lastname: Willert
authors.forename: K
authors.initials: K
authors.lastname: Murray
mesh_terms: D000328:Adult; D000368:Aged; D002400:Cathartics / Q000009:adverse effects*; D002951:Citrates / Q000009:adverse effects*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000009:adverse effects*; D010710:Phosphates / Q000009:adverse effects*; D010847:Picolines / Q000009:adverse effects*; D011092:Polyethylene Glycols / Q000009:adverse effects*; D011446:Prospective Studies; D015203:Reproducibility of Results; D016037:Single-Blind Method; D011795:Surveys and Questionnaires
chemical_list: D002400:Cathartics; D002951:Citrates; D009942:Organometallic Compounds; D010710:Phosphates; D010847:Picolines; D011092:Polyethylene Glycols; C005701:picosulfate sodium; C018279:sodium phosphate