Urinary Excretion of Polyethylene Glycol 3350 during Colonoscopy Preparation

Zusammenfassung

Hintergrund: Die Kolonlavage mit Polyethylenglycol(PEG)-Elektrolyt-Lösungen ist eine etablierte Methode zur Reinigung des Darmes für diagnostische und therapeutische Untersuchungen. Die intestinale Absorption von oral zugeführtem PEG wird bei gesunden Probanden als gering angesehen. Bei Patienten mit chronischentzündlichen Darmerkrankungen (CED) wurde zuvor über eine erhöhte Darmpermeabilität berichtet. In der vorliegenden Studie wurde die Absorption von PEG bei Patienten gemessen, die einer routinemäßigen Kolonlavage unterzogen wurden. Methodik/Ergebnisse: Bei 24 Patienten, die sich einer Kolonlavage mit einer PEG-3350-Elektrolytlösung unterzogen, wurde der 8-Stunden-Urin gesammelt. Der mit der Hochleistungsflüssigchromatographie gemessene Gehalt an PEG 3350 im Urin betrug zwischen 0,01 und 0,51 % der eingenommenen Menge (5,8 und 896 mg absolut). Die durchschnittliche PEG-Ausscheidung bei Patienten mit pathologisch veränderter Darmschleimhaut (0,24 % ± 0,19, n = 11) war nicht signifikant (p = 0,173) erhöht verglichen mit den Patienten, die eine makroskopisch normale Kolonschleimhaut aufwiesen (0,13 % ± 0,13, n = 13). Schlussfolgerung: Die intestinale Absorption von PEG 3350 ist höher als bislang angenommen und unterliegt einer hohen interindividuellen Varianz. Entzündliche Veränderungen der Darmschleimhaut bedingen nicht zwangsläufig eine erhöhte Permeabilität von PEG 3350.

Abstract

Background: Whole gut lavage with a polyethylene glycol electrolyte solution (PEG) is a common bowel cleansing method for diagnostic and therapeutic colon interventions. Absorption of orally administered PEG from the gastrointestinal tract in healthy human beings is generally considered to be poor. In patients with inflammatory bowel disease (IBD), intestinal permeability and PEG absorption were previously reported to be higher than in normal subjects. In the current study, we investigated the absorption of PEG 3350 in patients undergoing routine gut lavage. Methods and Results: Urine specimens were collected for 8 hours in 24 patients undergoing bowel cleansing with PEG 3350 for colonoscopy. The urinary excretion of PEG 3350, measured by size exclusion chromatography, ranged between 0.01 and 0.51 % of the ingested amount, corresponding to 5.8 and 896 mg in absolute amounts, respectively. Mean PEG excretion in patients with impaired mucosa such as inflammation or ulceration of the intestine (0.24 % ± 0.19, n = 11) was not significantly higher (p = 0.173) compared to that in subjects with macroscopically normal intestinal mucosa (0.13 % ± 0.13, n = 13). Conclusion: The results indicate that intestinal absorption of PEG 3350 is higher than previously assumed and underlies a strong inter-individual variation. Inflammatory changes of the intestine do not necessarily lead to a significantly higher permeability of PEG.

Schlüsselwörter

Polyethylenglycol - PEG - Golytely - Kolonlavage - Darmreinigung - chronisch entzündliche Darmerkrankungen - intestinale Permeabilität

Key words

Polyethylene glycol - PEG - macrogol - golytely - colon lavage - irrigation - intestinal absorption - inflammatory bowel disease - intestinal permeability

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