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"Problem-breaking" scheme! See how new secretagogues "assist" bowel preparation

 Last Update: 2022-11-05
 Source: Internet
 Author: User

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to Professor Song Jun takes you to see how low-dose PEG combined with linaclotide solves the "problem"
of intestinal preparation.

Colonoscopy is an important means of diagnosing and treating colonic lesions, but the accuracy of its diagnosis and the safety of treatment are closely related to
the quality of bowel preparation.
If the intestinal preparation is inadequate, the residual fecal water in the intestinal lumen will obscure the field of view, seriously affecting microscopic observation, resulting in an increased missed detection rate of colorectal lesions and polyps [1-2].

Studies have shown that the selection of safe, clean-effective, and low-adverse effects of bowel preparation, as well as enhanced patient education and improved patient compliance, are important for adequate bowel preparation [3,4].

So, what is the current situation of intestinal preparation in China? What are the factors that affect the quality of bowel preparation? Are there new protocols to further improve the quality of bowel preparation? The medical community specially invited Professor Song Jun from the Department of Gastroenterology, Tongji Medical College Affiliated Union Hospital, Huazhong University of Science and Technology, to share
this topic.

Intestinal preparation drugs and patient factors jointly affect the quality of intestinal preparation, and clinical needs to explore "better solutions"

Colorectal cancer (CRC) is the third most common cancer worldwide and the second leading cause
of cancer death.
According to statistics, there were about 1.
93 million new cases of colorectal cancer and 940,000 deaths in 2020 [5].

Colonoscopy is the key to the
diagnosis, prevention, and treatment of colorectal cancer.
The safety and effectiveness of colonoscopy depends largely on the preparation of
the bowel in advance.
Professor Song Jun said that high-quality bowel preparation can detect all polyps above 5mm and fully expose more than 90% of the mucous membrane, which is crucial for the detection of colorectal lesions
.

However, the current situation of intestinal preparation quality in China is not optimistic
.
Currently, the proportion of clinically inadequate bowel preparation is 29.
7% [6].

If patients have other risk factors, the proportion of inadequate bowel preparation may be further elevated [7].

"Therefore, in our clinical colonoscopy research, we are very focused on how to improve the adequacy and quality
of bowel preparation.
Professor Song Jun added
.

There are many factors that affect the quality of intestinal preparation, mainly involving three aspects, Professor Song Jun pointed out: "First, enteric preparation drugs, if the drug requires too much fluid intake and bitter taste, it will lead to poor patient tolerance; Second, it is related to the patient's physical factors, including the patient's age, gender, overweight, whether there are other diseases, whether he has been constipated in the past, or whether he has used antidepressants or anesthetics, etc.
, which will affect the quality of bowel preparation; Third, patient compliance is related to the patient's education level and economic conditions, including the patient's diet and whether the prescribed dose of laxative is completed in time [8].

”

Clinically, corresponding improvement programs
have gradually emerged.
Professor Song Jun introduced that first, for intestinal preparation drugs, the taste of the drug can be improved by changing the solution, combined with flavoring substitutes, etc.
, and a large amount of liquid can be improved by combining other auxiliary drugs; Second, for patients with special factors such as constipation, high blood pressure or drug factors, medical staff can make intestinal preparations by laxating in advance and waiting for the feces to be partially or completely discharged; Third, for patients with poor compliance due to unclear medical advice, notifications and reminders can be made through oral and illustrated instructions, joint phone calls, text messages, and mobile applications (apps), and for patients with less activity, patients can be encouraged to perform appropriate activities during bowel preparation [8].

Among the many improvement schemes, combining other adjuvant drugs to improve the quality of bowel preparation has attracted much attention
from scholars.
At present, the most widely used enteral preparation regimen is the 3L divided dose regimen of compound polyethylene glycol electrolyte dispersion (PEG) [7].

Professor Song Jun said that PEG is an isotonic intestinal cleanser that does not exchange water-electrolyte substances with the intestinal mucosa, but because it requires the amount of fluid intake to be greater than 3L, it is easy to have digestive tract symptoms
such as nausea and vomiting during the use of patients.
Therefore, while ensuring safety and effectiveness, it is urgent to improve the intestinal preparation adjuvant drugs or dosing regimens that improve
the large amount of fluid intake of PEG.
This leads to increased patient acceptance and better bowel preparation
.
Based on this, Wuhan Union Medical College Hospital conducted a study
on the improvement of bowel preparation.

Low-dose PEG combined with linalotide is a "problem-breaking" regimen for bowel preparation as evidenced by the latest research

"The original intention of our study was to explore a bowel preparation protocol that can both provide adequate bowel preparation and high patient acceptance, as a way to solve the problem
of inadequate bowel preparation in the clinic.
In the process of exploration, we noticed that a drug for constipation, linaclottide, can assist PEG in cleansing the bowel
.
Professor Song Jun introduced
.

"To validate the efficacy of a bowel preparation modification regimen for low-dose PEG plus linalottide, we designed a multicenter prospective study
.
" A total of 200 colonoscopy patients aged 16~65 years old were included in the study, and the subjects were randomly divided into two groups
: routine bowel preparation group and linaclotide improvement group according to the ratio of 1:1.

All patients are told how to properly prepare the bowel and perform a low/residue-free diet
for 3 days before the examination.
Indicators of testing include bowel preparation pass rate and bowel visual field rating to assess the quality of bowel preparation, as well as the rate
of patient willingness to retest to assess patient acceptance.

Professor Song Jun said that the preliminary results showed that there was no significant difference
between the two regimens in terms of the quality of bowel preparation.
The pass rate of bowel preparation exceeded 95% in both groups (conventional vs.
linalotide improvement: 98.
9% versus 96.
7%); The intestinal visual field rating was scored using the Boston scale, and it was found that there was no significant difference in the scores of the two groups in the three intestinal segments of the left colon, transverse colon and right colon, suggesting that the bowel preparation regimen of low-dose PEG combined with linaclotide could achieve the bowel preparation effect of conventional 3L or 4L PEG.
There was no clear difference
between the two sets of data for other outcomes such as the detection rate of intestinal polyps or adenomas.

In terms of patient acceptance, the linaclotide improvement group was better than the conventional group
.
The surveyed patient willingness ratio showed that nearly 50% of patients in the linaclotide modified group were willing to undergo colonoscopy again, which was better than the conventional group
.
"In addition, we also compared the proportion and severity
of abdominal discomfort symptoms such as bloating and abdominal pain before bowel preparation and during colonoscopy in the two groups.
" Professor Song Jun added, "The results show that the linaclotide modified group can significantly reduce the occurrence of abdominal discomfort symptoms and improve the comfort of patients during colonoscopy, which is also a factor
in patients' willingness to undergo colonoscopy again.
" "
Overall, the bowel preparation modification regimen of low-dose PEG combined with linaclotide can achieve the bowel preparation effect and lesion detection rate of 4L PEG, and can achieve higher patient acceptance
.
" Professor Song Jun concluded
.

The unique mechanism of double-effect of linaclotide empowers a new direction of intestinal preparation

Linarclotide is a selective guanylate cyclase-C (GC-C) receptor agonist clinically approved for the treatment of constipated irritable bowel syndrome (IBS-C) with a unique mechanism of dual action that can be passed through the GC-C pathway while increasing the concentration
of intracellular cyclic guanosine monophosphate (cGMP).
On the one hand, it promotes the secretion of intestinal juice and softens feces; On the other hand, the pain threshold is raised to relieve abdominal pain
.

Intracellular cGMP can phosphorylate cystic fibrosis transmembrane conduction regulator (CFTR) to open the ion channels of intestinal epithelial cells, increase the secretion of bicarbonate and chloride ions into the intestinal lumen, promote the secretion of intestinal fluid, soften feces, and significantly improve constipation; Extracellular cGMP can inhibit the excitability of primary sensory nerves in the intestines and reduce the release of neurotransmitters, thereby reducing pain nerve sensitivity, raising pain thresholds, and relieving abdominal pain [9].

Professor Song Jun said: "Based on the mechanism of action and the results of the study, we believe that the enteral preparation regimen of low-dose PEG combined with linaclotide has advantages
in reducing fluid volume, improving the quality of intestinal cleansing and increasing patient tolerance.
This provides a new option and guidance
for clinical preparation of bowel preparation.
At present, other related studies are being carried out simultaneously, and the results of the study are expected to be published
.

Speaking of his future expectations for bowel preparation, Professor Song Jun said: "The ideal bowel preparation program needs to have the characteristics
of high patient acceptance, low damage to the intestinal mucosa, good visualization effect of colonoscopy, affordable price and high accessibility.
Only in this way can we truly improve the rate of intestinal preparation, thereby improving the early detection rate of colorectal cancer and helping
to achieve 'Healthy China 2030'.
" Expert
Profile

Professor Song Jun

Member of the Collaborating Group of Physical and Mental Diseases of the Chinese Society of Gastroenterology
Member of the Endoscopic Diagnosis and Treatment Group of Esophagogastric Varices of the Chinese Medical Association Digestive Endoscopy
Member of the Tunnel Collaboration Group of the Digestive Endoscopy Branch of the Chinese Medical Association
Member of the Digestive Endoscopy Professional Committee of the Chinese Society of Integrative Medicine
Youth Vice Chairman of the Gastroenterology Branch of Integrated Traditional Chinese and Western Medicine of China Association for the Promotion of International Exchanges in Healthcare
Member of Digestive Endoscopy Branch of Hubei Medical Association
Member of the Standing Committee of the Gastroenterology Branch of Wuhan Medical Association

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at the references:[1] Du Xian, et al.
Journal of Hebei Medical University,2020,41(4):373-376 [2] Li Pan, et al.
Journal of Shandong University (Health Sciences),2020,58(3):113-117 [3] Wang Wei, et al.
China Contemporary Medicine, 2020, 27(33): 13-16 [4]Serper M,et al.
Clin Gastroenterol Hepatol.
2014 Mar; 12(3):451-7.
[5]Sung H,et al.
CA Cancer J Clin.
2021 May; 71(3):209-249.
[6]Liu X,et al.
Gut.
2014 Jan; 63(1):125-30.
[7] Chinese Journal of Digestive Endoscopy, 2019(07): 457-469 [8]Hassan C,et al.
Endoscopy.
2019; 51(8):775-794.
[9]Chey WD,et al.
Am J Gastroenterol 2012; 107:1702–1712.

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.
If you are not a healthcare professional, do not participate or spread
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