Gastroenterologists, PCPs should be alert for clinical factors that may predict inadequate bowel preparation

Liz Meszaros, MDLinx

Digestive Disease Week® (DDW)

San Diego, California, United States | May 21-24, 2016


San Diego, CA, May 21, 2016—Patient characteristics that may be predictive of inadequate bowel preparation include diabetes, psychiatric illness, opioid use, active tobacco use, a previous history of inadequate bowel preparation, and Medicaid, according to researchers here at Digestive Disease Week 2016. Being alert for these factors may help identify patients who may benefit from extended bowel preparations and more education prior to colonoscopy.

Take-home messages

  • Diabetes, psychiatric illness, opioid use, active tobacco use, a previous history of inadequate bowel preparation, and Medicaid are all clinical factors that may predict the likelihood of inadequate bowel preparation before colonoscopy.
  • Clinicians should be aware of these factors, and pay particular attention to patients who exhibit them, assigning more rigorous bowel prep scores, and educating patients better in what constitutes good bowel preparation.

“This study was conducted to identify clinical factors that may be associated with lower bowel prep scores, and if these clinical factors are found in patients, they can be used to assign a more rigorous bowel prep score or tell patients how to improve their bowel prep score,” explained lead researcher Saloni Shah, Yale University School of Medicine, New Haven, CT.

Shah and colleagues at Yale University conducted this retrospective, case-control study at a single outpatient procedure center that was affiliated with a tertiary care hospital. They reviewed charts of 1,055 patients who underwent screening for colonoscopy in a 1-year period, and included those with a Boston Bowel Preparation Scale (BBPS) score recorded in their colonoscopy report, as assessed by the endoscopist at the end of the colonoscopies.

They defined cases as those patients with a BBPS ≤ 5 (inadequate; n=189), and controls as those with BBPS ≥ 6 (adequate; n=866). Shah and colleagues recorded and analyzed patient characteristics, including demographics, medical history, medication use, socioeconomic factors, and colonoscopy findings, using Chi-square analysis for univariate, and binomial logistic regression modeling for multivariate analyses. Age, gender, ethnicity, employment status, and marital status were similar in cases and controls.

Shah and fellow researchers found the following characteristics to be more common in patients with inadequate bowel preparation: diabetes, psychiatric illness, ASA class ≥ 3, history of inadequate bowel preparation, smoker, opioid user, insulin user, and Medicaid (see Table 1).

Upon multivariable logistic regression, they also found that factors that were predictive of inadequate bowel preparation included diabetes (OR: 2.9; 1.8, 4.6), psychiatric illness (OR: 2.0; 1.3, 2.9), opioid use (OR: 1.7; 1.1, 2.6), active tobacco use (OR: 2.1; 1.4, 3.1), history of inadequate bowel preparation (OR: 7.2; 1.8, 28.9), and Medicaid (OR: 2.0; 1.4, 2.9) (see Table 2).

“If you find a patient who has any of these five characteristics, you should note them in the chart and assign a more rigorous bowel prep,” concluded Dr. Shah.