A feasibility study of probiotics pretreatment as a bowel preparation for colonoscopy in constipated patients

Background: The use of probiotics to treat constipation is based on the premise that supplying the gut with healthy bacteria in the form of probiotics can help normalize intestinal function. The aim of this study was to determine the efficacy of a 2-week probiotics pretreatment with oral sodium phosphate (NaP) for bowel cleansing before colonoscopy in patients with constipation. Methods: Patients with constipation were prospectively randomized to receive a 2-week probiotics course comprising a mixture of Bacillus subtilis and Streptococcus faecium (group A, n = 51) or placebo (group B, n = 53) with an oral NaP solution. During the same period, another 107 patients with normal bowel movement were enrolled and received the probiotics treatment (n = 53, group C) or placebo (n = 54, group D). The primary outcome measure was the quality of bowel cleansing. Postendoscopic symptoms were estimated using a visual analogue scale. Results: Patients having normal defecation presented with better bowel preparation than those with constipation (57.9% versus 37.5%; P = 0.003). Probiotics pretreatment (group A) was more effective at bowel cleansing for colonoscopy compared with placebo (group B) in constipated patients (54.9% versus 20.8%; P < 0.001). In contrast, preparation quality did not differ significantly between groups C and D. Preparation-related adverse events and postendoscopic symptoms were more frequent and severe in group B than in group A. Conclusion: Two weeks of probiotics pretreatment as part of bowel preparation significantly improves colonic mucosa visualization during colonoscopy and reduces preparation-related and postendoscopic gastrointestinal symptoms in constipated patients.