![]() Multiple studies have evaluated diabetic patients’ characteristics to determine the risk factors for inadequate bowel preparation ( Table 1). These changes include increased oxidative stress due to an excess of reactive oxygen species, a reduction in growth factors, changes in enteric microbiota, and alterations in signaling pathways and endothelial dysfunction. These gastrointestinal dysfunctions may be due to changes in the microenvironment of the autonomic nervous system, the enteric nervous system and the intestinal cells of Cajal. However, it has been suggested that decreased intestinal transit and slow gastric emptying may play a major role. The exact mechanism and pathophysiology behind inadequate bowel preparation in diabetic patients remain incompletely understood. In addition, the differences in the prevalence of other risk factors for poor bowel preparation might also play a role. This difference between the 2 populations might be explained by the differences in dietary habits, as Asian populations are thought to have more fibers and spicy food in their diet. In addition, sensitivity analysis showed that DM was significantly associated with poor bowel preparation in studies performed in western countries (OR 0.64, 95%CI 0.49-0.82 P<0.001), while studies performed in Asian countries did not show an association (OR 0.46, 95%CI 0.15-1.45 P=0.19). Sensitivity analysis showed that DM was associated with inadequate bowel preparation, whether split-dose (OR 0.67, 95%CI 0.48-0.92 P=0.01) or conventional bowel preparation (OR 0.43, 95%CI 0.24-0.80 P<0.001) was used. ![]() Similarly, another systematic review and meta-analysis by Mahmood et al reported that DM was a risk factor for inadequate bowel preparation (OR 0.58, 95%CI 0.43-0.79 P<0.001 I 2=85%). A systematic review and meta-analysis of 67 studies by Gandhi et al showed that DM had an odds ratio (OR) of 1.79 for inadequate bowel preparation (95% confidence interval 1.54-2.09 P=0.001 I 2=54%). ![]() The risk of inadequate bowel preparation in diabetic patients has been attributed to several factors, and physicians’ awareness of possible interventions can mitigate the risk of inadequate bowel preparation in these patients.ĭiabetes mellitus (DM) and bowel preparationĭM has been found in multiple studies to be an independent risk factor for inadequate bowel preparation for colonoscopy. Diabetic patients are at greater risk of having inadequate bowel perpetration, which can lead to missed neoplastic or preneoplastic lesions, longer procedural time, a greater risk of procedure-related adverse events, significant cost burden, and patient dissatisfaction. Patients with inadequate bowel preparation should undergo a repeat colonoscopy within 1 year. A complete colonoscopy requires cecal intubation and adequate preparation in order to visualize the entire colonic mucosa. The American Society of Gastrointestinal Endoscopy (ASGE) guidelines consider colonoscopy as a first-tier test for CRC screening, and about 17 million colonoscopies are performed annually in the United States (US). It can be used for the diagnosis and management of different colonic disorders as well as screening for colorectal cancer (CRC). ![]() ![]() Colonoscopy is a routine gastrointestinal diagnostic and therapeutic procedure that provides a direct visualization of the colonic lumen. ![]()
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