Endoscopic Disease Activity and Biologic Therapy Are Independent Predictors of Suboptimal Bowel Preparation in Patients with Inflammatory Bowel Disease Undergoing Colonoscopy

Optimal bowel preparation (BP) is critical for endoscopic assessment of inflammation and dysplasia in patients with inflammatory bowel disease (IBD). Comorbidities and patient-related factors have been associated with suboptimal BP (SOBP) in the general population. We sought to identify disease-specific characteristics that may impact the quality of BP in patients with IBD.

We conducted a retrospective analysis of adult IBD patients who underwent outpatient colonoscopies between January 2014 and September 2020 at a large academic medical center. Quality of BP was documented using the Boston Bowel Preparation Scale (BBPS) or the Aronchick scale and dichotomized into “suboptimal” (BBPS 0–5 or Aronchick “fair,” “poor,” unsatisfactory”) and “optimal” (BBPS 6–9 or Aronchick “excellent,” “good”). IBD-specific and other factors associated with SOBP were evaluated using logistic regression analyses.

Among a total of 395 IBD patients [54% males, mean age 40 years, 63% with Crohn’s disease (CD), 35% with ulcerative colitis (UC)], 24.8% had SOBP. On multivariable analysis, moderate-to-severe endoscopic disease vs mild or inactive disease was associated with a higher odds of SOBP [adjusted OR 2.7(95% CI 1.52–4.94)], whereas baseline biologic use was associated with a lower odds of SOBP [aOR 0.24(0.09–0.65)] among the overall IBD cohort. Additionally, age > 65 years [aOR 2.99(1.19–7.54)] and single-dose vs split-dose BP [aOR 2.37(1.43–3.95)] were predictors of SOBP. In the subgroup analysis by IBD type, moderate-to-severe endoscopic disease predicted SOBP among both CD and UC cohorts.

Endoscopic disease activity was predictive of SOBP, and biologic therapy was protective against SOBP among IBD patients.