Appetizing Edibles for Colonoscopy Bowel Prep in Development

Caroline Helwick

June 03, 2015

WASHINGTON, DC — Tasty menu items may soon replace the foul-tasting purgatives typically used to prepare the bowel for colonoscopy that are so difficult to swallow and unpopular with patients, they can impede cleansing.

"Not a day goes by that a patient of mine doesn't complain about our traditional preps," said Campbell Levy, MD, from the Dartmouth–Hitchcock Medical Center in Lebanon, New Hampshire.

The bad taste and the large volume of the purgative required for standard preps can impede adequate cleansing, which only about 75% of patients achieve.

"We have not made many advances in bowel preps over the years," Dr Levy told Medscape Medical News.

However, an edible preparation that "incorporates the purgatives into an appealing diet for patients" is challenging the notion that you have to fast and consume the commonly despised liquid before a colonoscopy, Dr Levy explained.

He presented results from a small pilot study here at Digestive Disease Week 2015.

Puddings, Pastas, Cereals, and Smoothies

The edible bowel cleansing product (ECP-018) is under development by Colonary Concepts. The conventional laxative PEG-3350, sorbitol, and ascorbic acid are incorporated into puddings, pasta salad, cereal, smoothies, and other low-residue foods.

In the study, 10 adults ate the food the day before and the morning of colonoscopy. Endoscopists graded the quality of the prep, and patients rated their satisfaction with it.

"We had very modest expectations going in," Dr Levy reported. "I thought it would take some reformulating, but we were pleasantly surprised to see that the first 10 patients we enrolled all had good to excellent global assessments of their prep."

In fact, the trial was stopped after the first 10 colonoscopies, in accordance with prespecified parameters, because colon cleansing was successful in all 10 patients.

On global assessment, endoscopists rated nine preps as good and one as excellent. In the ascending colon, there were three ratings of fair. In the transverse and descending colon, all ratings were good or excellent.

The application of this bowel prep would be enormous in pediatrics.

All 10 patients reported "no problems" and rated tolerability as high, and all indicated that they would choose this prep for a subsequent procedure. "That's not something you often hear from patients," Dr Levy pointed out.

A product such as this is "absolutely needed" and would be a big advance in bowel preparation, said Linda Rabeneck, MD, from the Sunnybrook Research Institute in Toronto, who has directed pivotal research in colon cancer screening.

"I don't think anyone would disagree with that. It can be arduous for some people," she explained. "When you talk to patients after the procedure, it's the thing they most remember and most complain about, not the procedure itself."

In fact, the burden of conventional bowel prep is probably keeping many people away from colonoscopy screening, she added.

"The application of this bowel prep would be enormous in pediatrics," said Christopher Hayes, MD, from the Baystate Children's Hospital in Springfield, Massachusetts. "Trying to get children of any age to take bowel preps, traditionally with only a clear liquid diet the day before their colonoscopy, is very hard on kids and their families," he told Medscape Medical News.

And he suggested that a food purgative could serve other purposes. In addition to colonoscopy preps, it could be used "for daily maintenance regimens for children with constipation who, over months and years, easily get medication fatigue," he said. "It becomes a power struggle between parents and kids that we may be able to ease."

Dr Levy reported that he is teaming up with Douglas Rex, MD, from Indiana University in Indianapolis, to conduct a two-center phase 2 study with a target enrollment of 80 patients.

Dr Levy, Dr Rabeneck, and Dr Hayes have disclosed no relevant financial relationships.

Digestive Disease Week (DDW) 2015: Abstract Su1525. Presented May 17, 2015.


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