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Polyethylene Glycol- or Sodium Picosulphate-Based Laxatives Before Colonoscopy in Children
Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Department of Intensive Care and Perioperative Medicine, Skåne University Hospital, Malmö, Sweden.ORCID iD: 0000-0003-0690-3940
Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV).ORCID iD: 0000-0002-8684-2537
Malmö högskola, Faculty of Health and Society (HS), Department of Care Science (VV). Skåne University Hospital, Malmö, Sweden; Department of Intensive Care and Perioperative Medicine, Skåne University Hospital, Malmö, Sweden.ORCID iD: 0000-0002-9300-6422
Skane University Hospital, Malmo, Sweden.
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2016 (English)In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 62, no 3, p. 414-419Article in journal (Refereed)
Abstract [en]

Objectives: The purpose of this randomised study was to compare the quality of bowel cleansing using either polyethylene glycol (PEG) or sodium picosulphate (NaPico) (primary outcome) in relation to the tolerability and acceptance of these laxatives among children and their caregivers (secondary outcome). Methods: The study was a randomised controlled trial that was conducted as an investigator-blinded study within the Department of Paediatrics of Ska°ne University Hospital in Malmo¨ , Sweden. A total of 72 children (10–18 years of age) were randomly placed into 1 of 2 groups (PEG or NaPico). The Ottawa Bowel Preparation Quality Score was used to evaluate the quality of bowel cleansing. A total of 2 different questionnaires were used to evaluate both the acceptability and tolerability of the laxatives. Results: In total, 71 children completed the bowel cleansing. Of these 71 cleanses, 67 protocols were analysed according to the Ottawa Bowel Preparation Quality Score. No significant difference in bowel cleansing quality was detected between the 2 groups. Rates of acceptability and tolerability were significantly higher in the NaPico group than in the PEG group. Conclusions: In the present study, both laxatives were found to be satisfactory in terms of aiding the performance of an uncomplicated and successful colonoscopy. NaPico was, however, more tolerable to the children than PEG, and both, the children and their caregivers, were more accepting of NaPico than of PEG. Consequently, NaPico can be recommended as the option for bowel cleansing in children ages 10 years and older. Key Words: bowel cleansing, children, colonoscopy, randomised controlled trial

Place, publisher, year, edition, pages
Lamy, Wolters Kluwer, 2016. Vol. 62, no 3, p. 414-419
Keywords [en]
bowel cleansing, children, colonoscopy, randomised controlled trial
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:mau:diva-14897DOI: 10.1097/MPG.0000000000000978ISI: 000371304000015PubMedID: 26360658Scopus ID: 2-s2.0-84959876546Local ID: 21901OAI: oai:DiVA.org:mau-14897DiVA, id: diva2:1418418
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-06-17Bibliographically approved
In thesis
1. Going trough a colonoscopy and living with inflammatory bowel disease: children's and parents' experiences and evaluation of the bowel cleansing quality prior to colonoscopy
Open this publication in new window or tab >>Going trough a colonoscopy and living with inflammatory bowel disease: children's and parents' experiences and evaluation of the bowel cleansing quality prior to colonoscopy
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis focuses on children aged 10-18 years with symptoms of, ordiagnosed with, inflammatory bowel disease (henceforth referred to as IBD).Before the disease can be diagnosed, a child must undergo several procedures,with colonoscopy as an established investigation, including bowel cleansing,which is crucial for the safe examination of the intestine. The prevalence ofpaediatric IBD is increasing worldwide, which will augment the number ofpaediatric colonoscopies. When the recommended laxative polyethylene glycol(PEG) was used for bowel cleansing, the children and their accompanyingparents experienced the procedure as difficult due to the large volume of badtastingPEG. Once IBD is diagnosed, the children must undergo lifelongmedical treatment, which entails several follow-up colonoscopies.Furthermore, IBD is a chronic illness with an unpredictable activity patternthat can have a negative impact on the children’s quality of life. One of theaims of this thesis was to explore a child/child’s perspective of going through acolonoscopy and child’s perspective of living with IBD. A further aim was toinvestigate whether sodium picosulphate (NaPico) can be used as an adequatealternative when the bowel is cleansed prior to colonoscopy in children.Three of the studies were interview studies (Papers I, II, & IV) with childrenand parents as participants. The data from 17 children and 12 parents (PapersI & II) was analysed using content analysis, and a phenomenologicalhermeneutic method was used when 7 children (Paper IV) were interviewed.The children’s experiences prior to colonoscopy (Paper I) were identified asbelonging to an overall theme, A private affair, which could be divided intofour categories: Preparing yourself, Mastering the situation, Reluctantlyparticipating, and Feeling emotional support. The result from the parents’ experiences when their child is undergoing an elective colonoscopy wasstructured into one theme, Charged with conflicting emotions, with threecategories: Being forced to force, Losing one’s sense of being a parent, andStanding without guidance (Paper II). The initial findings from these empirical studies undertaken served as apreparation for another study, aimed at comparing the quality of bowelcleansing using either PEG or sodium picosulphate (NaPico) in relation to thetolerability and acceptance of the laxatives among children and theiraccompanying parents (Paper III). This study was a randomised controlledtrial (RCT) that was conducted as an investigator-blinded study within theDepartment of Paediatrics at a university hospital in Sweden(www.clinicaltrials.gov, identifier NCT02009202). A total of 72 children wererandomly placed into one of two groups (PEG or NaPico). The Ottawa BowelPreparation Quality Scale (OBPQS) was used to evaluate the quality of thebowel cleansing. Two different questionnaires were used to evaluate both theacceptability and the tolerability of the laxatives. In total, 67 protocols wereanalysed according to the OBPQS. No significant difference in bowelcleansingquality was detected between the two groups. However, rates ofacceptability and tolerability were significantly higher in the NaPico group than in the PEG group, according to both the children and the parents. Finally, in order to illuminate the meaning of children’s lived experience ofIBD, an interview study with seven children was conducted. The meaning oftheir lived experience of IBD was interpreted as A daily struggle to adapt andto be perceived as normal. This interpretation was discussed in relation toIngmar Pörn’s theory of adaptedness (Paper IV). The findings point to the conclusion that both children’s and parents’perspectives are important, in order to improve the paediatric colonoscopy.The children (10-18 years) with symptoms of, or diagnosed with, IBD werereluctant to talk about their problems, including colonoscopy. However, theywere willing to share their experiences in order to help other children withsimilar problems, or in order to influence and improve paediatric care. Itemerged that both children and parents need to feel confident in their dealingswith healthcare professionals and to feel that healthcare professionals taketheir opinions seriously when preparing the child for colonoscopy. It is also important that the children have the opportunity to choose thebowel-cleansing protocol. NaPico can be recommended as the option forbowel cleansing in children aged 10 years and older. The meaning that can beextracted from the children’s experience of IBD is that they are struggling toadapt and to be perceived as normal. This is a conscious process entailing aconfrontation with various problems, such as ambitions and goals that arehard to achieve, due to reduced abilities resulting from the illness or from aninsufficiently adapted environment.

Place, publisher, year, edition, pages
Malmö university, Faculty of Health and Society, 2016. p. 89
Series
Malmö University Health and Society Dissertations, ISSN 1653-5383 ; 5
Keywords
Colonoscopy, Inflammatory bowel diseases, Randomised control trial, Content analysis, Phenomenological hermeneutics
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:mau:diva-7331 (URN)20697 (Local ID)9789171046819 (ISBN)20697 (Archive number)20697 (OAI)
Note

Paper III and IV not included in the fulltext online.

Paper IV in dissertation as manuscript.

Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-03-16Bibliographically approved

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Vejzovic, VedranaWennick, AnneIdvall, EwaBramhagen, Ann-Cathrine

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