title: The impact of opiate pain medications and psychoactive drugs on the quality of colon preparation in outpatient colonoscopy.
abstract: BACKGROUND
  Suboptimal colon preparation is a significant barrier to quality colonoscopy. The impact of pharmacologic agents associated with gastrointestinal dysmotility on quality of colon preparation has not been well characterized.
  
  
  OBJECTIVE
  Evaluate impact of opiate pain medication and psychoactive medications on colon preparation quality in outpatients undergoing colonoscopy.
  
  
  METHODS
  Outpatients undergoing colonoscopy at a single medical centre during a 6-month period were retrospectively identified. Demographics, clinical characteristics and pharmacy records were extracted from electronic medical records. Colon preparation adequacy was evaluated using a validated composite colon preparation score.
  
  
  RESULTS
  2600 patients (57.3 ± 12.9 years, 57% female) met the inclusion and exclusion criteria. 223 (8.6%) patients were regularly using opioids, 92 antipsychotics, 83 tricyclic antidepressants and 421 non-tricyclic antidepressants. Opioid use was associated with inadequate colon preparation both with low dose (OR = 1.4, 95%CI 1.0-2.1, p = 0.05) and high dose opioid users (OR = 1.7, 95%CI 1.1-2.9, p = 0.039) in a dose dependent manner. Other significant predictors of inadequate colon preparation included use of tricyclics (OR = 1.9, 95%CI 1.1-3.0, p = 0.012), non-tricyclic antidepressants (OR = 1.5, 95%CI 1.1-2.0, p = 0.013), and antipsychotic medications (OR = 2.2, 95%CI 1.4-3.4, p = 0.001).
  
  
  CONCLUSIONS
  Opiate pain medication use independently predicts inadequate quality colon preparation in a dose dependent fashion; furthermore psychoactive medications have even more prominent effects and further potentiates the negative impact of opiates with concurrent use.
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Vladimir M
authors.initials: VM
authors.lastname: Kushnir
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Pavan
authors.initials: P
authors.lastname: Bhat
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Reena V
authors.initials: RV
authors.lastname: Chokshi
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Brian B
authors.initials: BB
authors.lastname: Borg
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: Chandra Prakash
authors.initials: CP
authors.lastname: Gyawali
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St Louis, MO, USA. Electronic address: GSAYUK@wustl.edu.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Sayuk
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000701:Analgesics, Opioid / Q000009:adverse effects*; D000928:Antidepressive Agents / Q000009:adverse effects; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects*; D014150:Antipsychotic Agents / Q000009:adverse effects*; D002400:Cathartics / Q000627:therapeutic use*; D003113:Colonoscopy; D004305:Dose-Response Relationship, Drug; D005260:Female; D005769:Gastrointestinal Motility / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D014150:Antipsychotic Agents; D002400:Cathartics; D011092:Polyethylene Glycols
keywords: Cathartics; Colonoscopy; Opiate pain medications; Psychotropic drugs