The Effect of Irritable Bowel Syndrome on Bowel Preparation: A Retrospective Chart Review

Introduction: Irritable bowel syndrome (IBS) is a disorder of intestinal motility, resulting in abdominal discomfort and altered bowel habits. While it can significantly impact patients’ lives, it has an unclear impact on clinical and procedural outcomes, including colonoscopies. Poor prep can result in aborted colonoscopies, longer procedure times, missed polyps and increased costs. Few studies have examined the quality of prep in patients with IBS, despite it being a disorder of intestinal motility that may theoretically impact passage of prep through the bowel. Our goal is to examine differences in quality of bowel prep in patients with and without IBS. Methods: A retrospective chart review from a single center was conducted at University Hospital in Newark, NJ, examining patients who underwent colonoscopy with and without a diagnosis of IBS. Procedure reports were used to identify outcomes (bowel preparation quality, procedure time, number of polyps found). Type of bowel prep was identified. Baseline characteristics, including age, sex at birth and ethnicity were obtained. Chi-squared and independent samples t-tests were used to analyze categorical and continuous data respectively. Multiple logistic regression was used to control for confounders. Results: Patients without IBS were older. Most patients in both groups were female, but the IBS group had a greater proportion of females (82.7% versus 54.7%). Most patients were Black, followed by Hispanic. In terms of primary outcomes, differential rates of preparation agent use, preparation quality, and polyp numbers were statistically significant. Patients with IBS had fewer detected polyps on average (0.72 versus 1.26). Rates of preparation agent use differed among both groups: non-IBS patients were mostly given Golytely + Dulcolax (62.3%), followed by Golytely (33.3%). IBS patients were mostly given Golytely (49.3%), followed by Golytely + Dulcolax (47.8%). Preparation quality differed among both groups, with IBS patients having greater frequency of excellent preparation than their counterparts. Conclusion: Patients with IBS had better preparation quality which may be correlated with their younger age as they are at a reduced risk for colonic polyps as opposed to their older counterparts. IBS patients had less extensive preparations, possible due to IBS-associated symptoms. A large prospective study should be conducted for further results (Table 1). Table 1. - Patient demographics and primary outcomes No IBS (n=150) IBS (n=150) Mean Age in Years (SD) 63.93 (9.76) 58 (13.05) Mean BMI (SD) 29.8 (6.45) 29.21 (6.03) Sex Male (%) 68 (45.3) 26 (17.3) Female (%) 82 (54.7) 124 (82.7) Race White (%) 2 (1.3) 14 (9.3) Black (%) 102 (68) 63 (42) Hispanic (%) 24 (16) 23 (15.3) Asian/Pacific Islander (%) 0 (0) 3 (2) Other (%) 22 (14.7) 47 (31.3) No IBS (n=150) IBS (n=150) Odds Ratio (CI) P-value Adjusted Odds Ratio (ACI) Adjusted P-value Prep Agent (%) Golytely 46 (33.3) 66 (49.3) n/a 0.028 2.8x106 (6.5x105 to 1.2x107) < 0.001 Golytely + Dulcolax 86 (62.3) 64 (47.8) Golytely + Dulcolax + Miralax 6 (4.3) 4 (3) Prep Quality (%) Excellent 49 (32.7) 68 (46.9) n/a 0.005 0.477 (0.059 to 3.875) 0.488 Good 38 (25.3) 19 (13.1) Fair 29 (19.3) 36 (24.8) Poor 34 (22.7) 22 (15.2) Presence of Fellow (%) 103 (70.5) 118 (81.9) 1.895 (1.089 to 3.297) 0.023 0.807 (0.142 to 4.569) 0.807 Opioid Use (%) 12 (8) 5 (3.3) 0.397 (0.136 to 1.155) 0.08 0.248 (0.018 to 3.485) 0.301 Diabetes (%) 55 (36.7) 50 (33.3) 0.864 (0.537 to 1.389) 0.545 1.266 (0.334 to 4.791) 0.728 Standard Error (CI) P-value Mean Procedure Time in Minutes (SD) 23.48 (12.3) 23.42 (11.1) 1.787 (-3.46 to -3.59) 0.201 Mean Number of Polyps (SD) 1.26 (1.57) 0.72 (1.1) 0.158 (0.231 to 0.854) 0.001 IBS = irritable bowel syndrome; SD = standard deviation; n = sample size, SD = standard deviation.