What Factors Predict Suboptimal Bowel Preparation in Patients With IBD?

IBD-specific factors like endoscopic disease activity is predictive of suboptimal bowel preparation in patients undergoing colonoscopy.

Endoscopic disease activity can help predict suboptimal bowel preparation (SOBP), and biologic therapy may protect against SOBP in patients with inflammatory bowel disease (IBD), according to study results presented at the American College of Gastroenterology (ACG) 2022 Annual Meeting, held from October 21 to 26, 2022, in Charlotte, North Carolina, and virtually.

The retrospective analysis included adult patients with IBD who had outpatient colonoscopies from January 2011 to October 2021 at 3 large academic medical centers. Patients who had total colectomy or sigmoidoscopy only were excluded.

The quality of bowel preparation (BP) was assessed using the Boston Bowel Preparation Scale (BBPS) or the Aronchick scale and was grouped into “suboptimal” (BBPS 0-5 or Aronchick “fair,” “poor,” or unsatisfactory”) and “optimal” (BBPS 6-9 or Aronchick “excellent,” “good”).

The primary goal was to evaluate IBD-specific factors that are associated with SOBP.

Improved inflammatory control using biologic therapies may also improve quality of BP among IBD patients undergoing colonoscopy.

A total of 1154 patients with IBD (mean age, 47±17 years; women, 53%) were included, of whom 23.5% had SOBP. Of the cohort, 58% had Crohn disease (CD), 40% had ulcerative colitis (UC), 23% had moderate to severe disease, and 40% were receiving biologic therapy. About 94% of patients achieved cecal or anastomotic intubation.

Moderate to severe endoscopic disease compared with mild or inactive disease was associated with higher odds of SOBP (odds ratio [OR], 2.34 [1.60-3.43]), and baseline biologic use was associated with lower odds of SOBP (OR, 0.67 [0.47-0.96]) in the overall IBD cohort, according to multivariable analysis. In addition, age over 65 years (OR, 1.80 [1.11-2.90]) and hypertension (OR, 1.73 [1.06-2.82]) were predictive of higher odds. Split-dose (vs single-dose) BP (OR, 0.52 [0.32-0.83]) was predictive of lower odds of SOBP in patients with IBD.

Biologic therapy use, age over 65 years, and split-dose BP were predictors of SOBP for participants with UC and CD, and stricturing phenotype predicted SOBP in the CD group in the subgroup analysis.

“Improved inflammatory control using biologic therapies may also improve quality of BP among IBD patients undergoing colonoscopy,” the study authors wrote.

Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Kumar A, Bae E, Osemi E, et al. Endoscopic disease activity and biologic therapy are independent predictors of suboptimal bowel preparation in patients with inflammatory bowel disease undergoing colonoscopy: a multicenter analysis. Abstract presented at: ACG 2022 Annual Meeting; October 21-26, 2022; Charlotte, NC. Abstract B0372.