Carbon Dioxide-Insufflating Colonoscopy in Patients With IBS
Carbon Dioxide-Insufflating Colonoscopy in Patients With IBS
Background and Aim: Colonoscopy has the disadvantage of pain and discomfort for patients. It has been shown in randomized controlled trials that carbon dioxide (CO2) insufflations significantly reduce pain and discomfort in patients undergoing colonoscopy. However, there have been no studies in which CO2 insufflation in colonoscopy of patients with irritable bowel syndrome (IBS) was investigated.
Methods: Randomized double-blind controlled study was conducted to assess the suffering from colonoscopy in patients with IBS and the efficacy of CO2 insufflation in colonoscopy for patients with IBS. Patients with IBS and controls who received colonoscopy were randomized into an air or CO2 insufflation group. Patients' symptoms such as distension and pain were compared using a 10-cm visual analog scale (VAS).
Results: There were 18 patients in the IBS/air group, 19 patients in the IBS/CO2 group, 25 patients in the control/air group and 26 patients in the control/CO2 group. The mean value of severity of distension after colonoscopy and the mean value of severity of pain from during examination to one hour after the examination were higher in the IBS group than in the control group. The severity of these symptoms was reduced earlier in the CO2 group. CO2 insufflation in colonoscopy was more effective in the IBS group than in the control group from 15 min to one hour after the examination.
Conclusion: Regarding colonoscopy-related suffering, IBS patients showed significant differences from non-IBS patients. CO2 insufflation in colonoscopy is effective for IBS patients, particularly for patients who commence activities after colonscopy.
Colonoscopy is useful for screening individuals at risk for colorectal cancer or premalignant lesions. However, colonoscopy has the disadvantage of abdominal pain and discomfort for patients. Insufflation of air during colonoscopy is one of the reasons for the unacceptability of patients. It has been shown in randomized controlled trials that carbon dioxide (CO2) insufflation significantly reduces abdominal pain and discomfort in patients undergoing colonoscopy. Moreover, it has been shown that the use of CO2 during colonoscopy has no adverse effects. Bretthauer et al. reported that CO2 insufflation is safe during colonoscopy in unsedated patients with no rise in end-tidal CO2 level. Nevertheless, air insufflation in colonoscopy is considered the standard method in most centers because of a lack of suitable equipment and improvement of colonoscopic skill. Recently, CO2 insufflation has been reconsidered for lengthy endoscopic treatment such as endoscopic submucosal dissection (ESD).
Irritable bowel syndrome (IBS) is one of the most important clinical problems in modern gastroenterology. Disorders of intestinal motility, visceral hypersensitivity, psychological disorder and the presence of an altered brain-gut interaction have been considered to play roles in the pathophysiology of IBS. Patients with IBS showed spontaneous colonic hypermotility that was also evoked by psychological stress, physical stress and chemical stimuli. Fukudo et al. demonstrated stress-induced hypermotility of the colon in patients with IBS. In addition, they found evidence of small intestinal and duodenal dysmotility in patients with IBS, and they suggested that patients with IBS have exaggerated responsivity of the gut and the brain to stress. Visceral sensitivity can be quantitatively assessed using a barostat. Patients with IBS have been shown to have visceral hypersensitivity, allodynia and hyperalgesia.
There have been no studies in which CO2 insufflation in colonoscopy of patients with IBS was investigated. In this trial, the primary endpoint was to investigate the degree of colonoscopy-related suffering in patients with IBS and in patients without IBS. In addition, the secondary endpoint was to investigate the degree of suffering from CO2 or air insufflation in patients with IBS.
Abstract and Introduction
Abstract
Background and Aim: Colonoscopy has the disadvantage of pain and discomfort for patients. It has been shown in randomized controlled trials that carbon dioxide (CO2) insufflations significantly reduce pain and discomfort in patients undergoing colonoscopy. However, there have been no studies in which CO2 insufflation in colonoscopy of patients with irritable bowel syndrome (IBS) was investigated.
Methods: Randomized double-blind controlled study was conducted to assess the suffering from colonoscopy in patients with IBS and the efficacy of CO2 insufflation in colonoscopy for patients with IBS. Patients with IBS and controls who received colonoscopy were randomized into an air or CO2 insufflation group. Patients' symptoms such as distension and pain were compared using a 10-cm visual analog scale (VAS).
Results: There were 18 patients in the IBS/air group, 19 patients in the IBS/CO2 group, 25 patients in the control/air group and 26 patients in the control/CO2 group. The mean value of severity of distension after colonoscopy and the mean value of severity of pain from during examination to one hour after the examination were higher in the IBS group than in the control group. The severity of these symptoms was reduced earlier in the CO2 group. CO2 insufflation in colonoscopy was more effective in the IBS group than in the control group from 15 min to one hour after the examination.
Conclusion: Regarding colonoscopy-related suffering, IBS patients showed significant differences from non-IBS patients. CO2 insufflation in colonoscopy is effective for IBS patients, particularly for patients who commence activities after colonscopy.
Introduction
Colonoscopy is useful for screening individuals at risk for colorectal cancer or premalignant lesions. However, colonoscopy has the disadvantage of abdominal pain and discomfort for patients. Insufflation of air during colonoscopy is one of the reasons for the unacceptability of patients. It has been shown in randomized controlled trials that carbon dioxide (CO2) insufflation significantly reduces abdominal pain and discomfort in patients undergoing colonoscopy. Moreover, it has been shown that the use of CO2 during colonoscopy has no adverse effects. Bretthauer et al. reported that CO2 insufflation is safe during colonoscopy in unsedated patients with no rise in end-tidal CO2 level. Nevertheless, air insufflation in colonoscopy is considered the standard method in most centers because of a lack of suitable equipment and improvement of colonoscopic skill. Recently, CO2 insufflation has been reconsidered for lengthy endoscopic treatment such as endoscopic submucosal dissection (ESD).
Irritable bowel syndrome (IBS) is one of the most important clinical problems in modern gastroenterology. Disorders of intestinal motility, visceral hypersensitivity, psychological disorder and the presence of an altered brain-gut interaction have been considered to play roles in the pathophysiology of IBS. Patients with IBS showed spontaneous colonic hypermotility that was also evoked by psychological stress, physical stress and chemical stimuli. Fukudo et al. demonstrated stress-induced hypermotility of the colon in patients with IBS. In addition, they found evidence of small intestinal and duodenal dysmotility in patients with IBS, and they suggested that patients with IBS have exaggerated responsivity of the gut and the brain to stress. Visceral sensitivity can be quantitatively assessed using a barostat. Patients with IBS have been shown to have visceral hypersensitivity, allodynia and hyperalgesia.
There have been no studies in which CO2 insufflation in colonoscopy of patients with IBS was investigated. In this trial, the primary endpoint was to investigate the degree of colonoscopy-related suffering in patients with IBS and in patients without IBS. In addition, the secondary endpoint was to investigate the degree of suffering from CO2 or air insufflation in patients with IBS.
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