Risk of hemorrhagic gastropathy associated with colonoscopy bowel preparation using oral sodium phosphate solution

Background and study aims: Oral sodium phosphate (NaP) solution is widely used for colonoscopy bowel preparation and it may cause aphthous ulcers in the colon. Our aim was to evaluate whether oral NaP solution is associated with gastric mucosal lesions.

Methods: A total of 20 070 individuals underwent esophagogastroduodenoscopy (EGD) with colonoscopy, and 4271 individuals underwent EGD without colonoscopy, for cancer screening. Oral NaP solutions were used for bowel preparation prior to colonoscopy. Hemorrhagic gastropathy was graded using a five-point scale for erosive mucosal injury. The effect of NaP bowel preparation on hemorrhagic gastropathy was estimated using multiple logistic regression analysis with odds ratios (ORs) and 95 % confidence intervals (CIs).

Results: The incidence of hemorrhagic gastropathy was 1.6 % (70/4271) in the EGD only group and 4.0 % (809/20 070) in the EGD with colonoscopy group (P < 0.001, unadjusted OR 2.55, 95 %CI 1.99 – 3.27). The ORs for mild (grade 1 – 2), moderate (grade 3), and severe (grade 4) hemorrhagic gastropathy according to NaP use were 1.92 (95 %CI 1.45 – 2.54), 4.72 (95 %CI 2.65 – 8.47), and 5.99 (95 %CI 1.46 – 24.63), respectively. After adjustment for confounding factors, NaP solution was a significant risk factor for acute hemorrhagic gastropathy in the multivariate analysis (OR 1.92, 95 %CI 1.34–2.74). In addition, male sex, a body mass index (kg/m²) of less than 20, concurrent use of antihypertensive or nonsteroidal anti-inflammatory drugs, and duodenal ulcers were independently associated with the development of hemorrhagic gastropathy. Helicobacter pylori infection and atrophic gastritis were negatively associated with hemorrhagic gastropathy.

Conclusion: Oral NaP bowel preparation for colonoscopy was associated with hemorrhagic gastropathy.

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