Diet Adjustment Before Colonoscopy Can Improve the Quality of Bowel Preparation in Patients with Schizophrenia

Diet Adjustment Before Colonoscopy Can Improve the Quality of Bowel Preparation in Patients with Schizophrenia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Diet Adjustment Before Colonoscopy Can Improve the Quality of Bowel Preparation in Patients with Schizophrenia Yuan-Rung Li, Wei-En Chang, Ying-Che Huang, Chih-Feng Wang, Feng-Woei Tsay This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4217392/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Quality of bowel preparation is crucial in colonoscopy. However, patients with schizophrenia are prescribed antipsychotic medicines, which may influence the effect of bowel preparation for colonoscopy. Poor quality of bowel preparation can reduce the benefit of colonoscopy, and increase the risk of overlooking possible colorectal cancers. Aim: This study aimed to employ diet adjustment before colonoscopy to improve the quality of bowel preparation. Method: Since January 2022, patients with schizophrenia at our institute requiring colonoscopy examination were divided into a standard group and a diet-modified groups. The standard group was initiated with a low-residue diet two days before and a clean liquid diet the day before the colonoscopy examination. The diet-modified group was initiated with a low-residue diet four days before and a clean liquid diet two days before the colonoscopy examination. Both groups were administered bowel cleansing medicines the day before and the morning of the examination. We used the Aronchick bowel preparation scale to evaluate the quality of bowel preparation. Result: From January 2022 to September 30, 2022, the quality of bowel preparation was poor in 25/325 (7.69%) non-schizophrenic patients and 32/135 (23.70%) patients with schizophrenia (p < 0.001). The quality of bowel preparation was poor in 20/59 (33.90%) and 12/76 (15.79%) patients of the standard and the diet-modified groups, respectively (p = 0.014). Conclusions: Diet adjustment before colonoscopy can be used to improve the quality of bowel preparation in patients with schizophrenia. colonoscopy prepare schizophrenia diet adjustment Figures Figure 1 Figure 2 Introduction Globally, colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of cancer-related deaths. Therefore, its early detection is crucial. Currently, several countries employ fecal occult blood tests for the early detection of colorectal cancer. An individual with a positive fecal occult blood test is recommended to undergo further evaluation with a colonoscopy. The effectiveness of colon cleansing in colonoscopy is closely linked to the detection rate of polyps. Poor colon cleansing reduces the detection rate of colonic polyps, leading to an increased in the incidence of interval cancers and a simultaneous decrease in cancer detection rates [1-4]. Furthermore, poor cleansing can extend the duration of colonoscopy, cause discomfort to the patient, increase the risk of complications, and unnecessary increase in healthcare costs [5-10]. Therefore, it is recommended that colon cleansing achieves > 90% visibility of the colonic surface in colonoscopy [11]. Currently, several drugs exist that alter the osmotic pressure to enhance colon cleansing before a colonoscopy, which are often administered in multiple doses to improve the effectiveness [12-14]. However, a certain subset of patients, particularly those with schizophrenia respond less favorably to these drugs. Patients with schizophrenia often use antipsychotic medications, antidepressants, and antianxiety medications to manage their condition. Based on their pharmacological effects, antipsychotic and antidepressant medications decrease gastrointestinal motility, which can lead to constipation. The effectiveness of colon cleansing medications is decreased in these patients, making it challenging to detect colonic polyps [5-6]. Therefore, this study aimed to assess whether dietary modifications can enhance colon cleansing during colonoscopy, consequently increasing the detection rates of colonic polyps and colorectal cancer. Patients And Method This retrospective study collected data from patients who underwent colonoscopies at our hospital from 2021 to September 2022. The exclusion criteria included patients <20 years old and those who underwent only sigmoidoscopy. Patients diagnosed with schizophrenia were defined by psychiatrists based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria [15]. Throughout the entire year of 2021, patients with schizophrenia and nonschizophrenic patients undergoing colonoscopy adhered to the same preparation regimen regarding dietary restrictions and dosage of bowel-cleansing medication. The precolonoscopy dietary preparation involved standard colonoscopy dietary protocol: a low-residue diet for the two days preceding and a clear liquid diet on the day before the procedure. The bowel preparation solution, polyethylene glycol (PEG), was administered on the evening of the day before and the morning of the day of the examination [16]. Since January 2022, patients with schizophrenia at our institute requiring colonoscopy examination were divided into a standard and diet-modified groups. The standard group was initiated on a low-residue diet two days before and a clean liquid diet the day before the colonoscopy examination. The diet-modified group was initiated on a low-residue diet four days before and a clean liquid diet two days before the colonoscopy examination. Nonschizophrenic patients undergoing colonoscopy followed a standard dietary preparation protocol, comprising a low-residue diet for the two days preceding the examination and a clear liquid diet the day before the procedure. The timing of administering the bowel-cleansing medication and PEG was consistent for the patients with schizophrenia and the nonschizophrenic patients, with the medication being administered on the evening before and the morning of the day of the examination. We used the Aronchick bowel preparation scale to evaluate the quality of bowel preparation, and the preparation quality of the entire colon was assessed as follows: 1, excellent (small volume of clear liquid or >95% of surface seen); 2, good (large volume of clear liquid covering 5%-25% of the surface but >90% of surface seen); 3, fair (some semisolid stool that could be suctioned or washed away but >90% of surface seen); 4, poor (semisolid stool that could not be suctioned or washed away and 5 years of experience in performing colonoscopies, and they have conducted >1500 colonoscopy procedures each. All statistical analyses were performed using the Statistical Packages for the Social Sciences (SPSS) Ver. 20.0 (IBM Corp., Armonk, NY, USA). Fisher’s exact test and the chi-square test were employed to compare the categorical variables. Student t-test was performed to compare the continuous variables. The statistical tests were two-sided, and the statistical significance was defined as p < 0.05. Results During the study period, in 2021, a total of 343 nonschizophrenic patients and 209 patients with schizophrenia underwent colonoscopy examinations. From January to September 2022, a total of 325 nonschizophrenic patients and 135 patients with schizophrenia underwent colonoscopy examinations. Among the patients with schizophrenia, 76 received dietary adjustments, whereas 59 followed the standard colonoscopy dietary protocol. Table 1 listed the baseline patient characteristics. In 2021, among the nonschizophrenic patients who underwent colonoscopy, the colon cleansing effectiveness was as follows: Excellent: 148, good: 116, fair: 43, and poor: 36 cases. For patient with schizophrenia who underwent colonoscopy during the same period, the colon cleansing effectiveness was as follows: Excellent: 39, good: 39, fair: 59, and poor: 72 cases. The quality of bowel preparation was poor in 36/343 (10.50%) nonschizophrenic patients and 72/209 (34.45%) patients with schizophrenia in 2021 (p < 0.001). (Fig. 1) From January 2022 to September 30, 2022, the quality of bowel preparation was poor in 25/325 (7.69%) nonschizophrenic patients and 32/135 (23.70%) patients with schizophrenia (p < 0.001). The quality of bowel preparation was poor in 20/59 (33.90%) patients of the standard group and 12/76 (15.79%) patients of the diet-modified group (p = 0.014). (Fig. 2) Patients with schizophrenia and nonschizophrenic patients undergoing colonoscopy showed a similar incidence rate of colorectal cancer, with no statistically significant difference. (patients with schizophrenia 3/344 vs. nonschizophrenic patients 14/668, p = 0.151) Discussion The proportion of patients with schizophrenia in various countries is approximately 0.5%-1% of the total population [18]. However, in the town of Yuli in Taiwan, which serves as a chronic care community for patients with schizophrenia, individuals with schizophrenia live alongside the general population. Thus, the percentage of individuals with schizophrenia is quite high, currently accounting for approximately one-fourth of the population. Consequently, bowel cleansing is important for patients with schizophrenia before undergoing colonoscopy. Previous studies have shown that the use of antipsychotic medications can reduce the effectiveness of colon cleansing during colonoscopy [19]. This study observed that, during the year 2021, compared with nonschizophrenic patients, those with schizophrenia had significantly poorer colon cleansing. However, dietary adjustments conducted as part of the precolonoscopy preparation in 2022 showed that the effectiveness of colon cleansing significantly improved. Nevertheless, a notable difference in the effectiveness of colon cleansing existed when compared with nonschizophrenic patients. Previous research has indicated that, compared with nonschizophrenic patients, those with schizophrenia possess a higher incidence of colorectal cancer [20]. However, this trend was not observed in this study. There are two potential reasons for this discrepancy, which are as follows: 1. Exclusion of patients with poor colon cleansing: Patients with poor colon cleansing may have been excluded from the study, resulting in the inclusion of patients with advanced colorectal cancer, thereby skewing the results. 2. Delayed diagnosis or poor colonoscopy quality: Patients with schizophrenia might experience delays in diagnosis or suboptimal colonoscopy quality due to poor colon cleansing. This could lead to misdiagnosis or delayed detection of colorectal cancer, thereby contributing to an apparent decrease in colorectal cancer rates among these patients. The observed differences in colorectal cancer rates between patients with schizophrenia and nonschizophrenic patients in this study could be influenced by factors related to colon cleansing effectiveness, delayed diagnosis, or the quality of the colonoscopy procedures. Further research is needed to fully understand these factors and their impact on colorectal cancer rates in patients with schizophrenia. This study had some limitations. We were unable to investigate the correlation between the dosage and types of medications used for schizophrenia and the effectiveness of colon cleansing. Among the included patients with schizophrenia, many of them had been on medication for several decades, and the types and dosages of medications might have gradually decreased gradually due to factors, such as cognitive decline, stroke, or aging. However, the impact of previous medications on the colon is often irreversible, leading to structural changes. Therefore, establishing a robust correlation between the types or dosages of medications and the current effectiveness of colonoscopy preparation is challenging. Furthermore, this study had a retrospective design, and future prospective studies are needed to provide more conclusive evidence. In conclusion, diet adjustment before colonoscopy can be used to improve the quality of bowel preparation in patients with schizophrenia. Declarations Conflict of interest statement and financial support statement: All authors have and declare that: there are no other relationships or activities that could appear to have influenced the submitted work. The study was no funding. Ethic Approval and informed consent The IRB of study was approved on Mar. 15, 2023 by Kaohsiung Veterans General Hospital. The IRB Number is KSVGH23-CT3-14. This is a retrospective study. The study has been granted exemption from ethics approval due to using irreversible anonymised data, so there is no informed consent. The research is conducted according to the principles of the Declaration of Helsinki. References Marmo R, Rotondano G, Riccio G, et al. Effective bowel cleansing before colonoscopy: a randomized study of split-dosage versus non-split dosage regimens of high-volume versus low- volume polyethylene glycol solutions. Gastrointest Endosc. 2010; 72:313–320. https://doi.org/10.1016/j.gie.2010.02.048 Lebwohl B, Kastrinos F, Glick M, et al. The impact of suboptimal bowel preparation on adenoma miss rates and the factors associated with early repeat colonoscopy. Gastrointest Endosc. 2011; 73:1207–1214. https://doi.org/ 10.1016/j.gie.2011.01.051 Chokshi RV, Hovis CE, Hollander T, et al. Prevalence of missed adenomas in patients with inadequate bowel preparation on screening colonoscopy. Gastrointest Endosc. 2012; 75:1197–1203. https://doi.org/10.1016/j.gie.2012.01.005 Oh YS. What are we missing when colon preparation is inadequate? Gastrointestinal endoscopy. 2012; 75:1204–1205. https://doi.org/10.1016/j.gie.2012.02.035 Hassan C, Fuccio L, Bruno M, et al. A predictive model identifies patients most likely to have inadequate bowel preparation for colonoscopy. Clin Gastroenterol Hepatol. 2012; 10:501–506. https://doi.org/10.1016/j.cgh.2011.12.037 Lebwohl B, Wang TC, Neugut AI. Socioeconomic and other predictors of colonoscopy preparation quality. Dig Dis Sci. 2010; 55:2014–2020. https://doi.org/10.1007/s10620-009-1079-7 Borg BB, Gupta NK, Zuckerman GR, et al. Impact of obesity on bowel preparation for colonoscopy. Clin Gastroenterol Hepatol. 2009; 7:670–675. https://doi.org/10.1016/j.cgh.2009.02.014 Crispin A, Birkner B, Munte A, et al. Process quality and incidence of acute complications in a series of more than 230,000 outpatient colonoscopies. Endoscopy. 2009; 41:1018–1025. https://doi.org/10.1055/s-0029-1215214 Froehlich F, Wietlisbach V, Gonvers JJ, et al. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. Gastrointest Endosc. 2005; 61:378–384. https://doi.org/10.1016/s0016-5107(04)02776-2 Rex DK, Imperiale TF, Latinovich DR, et al. Impact of bowel preparation on efficiency and cost of colonoscopy. Am J Gastroenterol. 2002; 97:1696–1700. https://doi.org/10.1111/j.1572-241.2002.05827.x Juluri R, Eckert G, Imperiale TF. Meta-analysis: randomized controlled trials of 4-L polyethylene glycol and sodium phosphate solution as bowel preparation for colonoscopy. Aliment Pharmacol Ther 2010; 32: 171-181 https://doi.org/10.1111/j.1365-2036.2010.04326.x Di Palma J, Rex D. Advances in bowel preparations: new formulation and clinical results. Gastroenterol Nurs. 2011; 34(Suppl 2):S2–8. https://doi.org/10.1097/SGA.0b013e31823080ef Parente F, Marino B, Crosta C. Bowel preparation before colonoscopy in the era of mass screening for colo-rectal cancer: a practical approach. Dig Liver Dis. 2009; 41:87–95. https://doi.org/10.1016/j.did.2008.06.005 Millien VO, Mansour NM. Bowel preparation for colonoscopy in 2020: A look at the Past, Present, and Future. Curr Gastroenterol Rep. 2020; 22 (6):28. https://doi.org/10.1007/s11894-020-00764-4 Rajiv T, Wolfgang G, Deanna M, et al. Definition and description of schizophrenia in DSM-5. Schizophrenia Research 2013;150:3-10. https://doi.org/10.1016/j.schres.2013.05.028 Alawi S, Dhahab H, Salmi I. Split dose bowel preparation before colonoscopy of PEG (Nulytely) in comparison to routine single dose bowel preparation. Saudi Journal of Gastroenterology 2021; 27(4): 234-239. https://doi.org/10.4103/sjg.sjg_563_20 Aronchick CA, Lipshutz WH, Wright SH, Dufrayne F, Bergman G. Validation of an instrument to assess colon cleansing [abstract]. Am J Gastroenterol 1999;94:2667. Jauhar S, Johnstone M, McKenna PJ. Schizophrenia. Lancet. 2022; 399: 473-486. https://doi.org/10.1016/S0140-6736(21)01730-X Vladimir MK, Pavan B, Reena VC, et al. The Impact of opiate pain medications and psychoactive drugs on the quality of colon preparation in outpatient colonoscopy. Dig Liver Dis. 2014; 46(1): 56-61. https://doi.org/10.1016/j.did.2013.07.020 Julia HC, Yana V, Carol C, et al. Risk of Malignancy in Patients With Schizophrenia or Bipolar Disorder. Arch Gen Psychiatry 2007; 64(12): 1368-1376. https://doi.org/10.1001/archpsyc.64.12.1368 Tables Table 1. Demographic information of patient receiving colonoscopy in 2021 and 2022 2021 Non-schizophrenic patient group (N = 343) Patient with schizophrenia group (N = 209) p value Sex (M) 193 (56.27%) 135 (64.59%) 0.053 Age 59.91 (15.32) 62.03 (12.38) 0.092 Hypertension 75 (21.87%) 88 (42.11%) <0.001 * Diabetes mellitus 49 (14.29%) 41 (19.62%) 0.100 Smoking 71 (20.70%) 36 (17.22%) 0.316 Alcohol 39 (11.37%) 17 (8.1%) 0.382 2022 Non-schizophrenic patient group (N = 325) Patient with schizophrenia standard group (N = 59) Patient with Schizophrenia diet-modified group (N = 76) p value Sex (M) 175 (53.85%) 33 (55.93%) 47 (61.84%) 0.449 Age 60.89 (14.01) 61.07 (12.48) 59.02 (11.34) 0.527 Hypertension 57 (17.54%) 26 (44.07%) 23 (30.26%) <0.001 * Diabetes mellitus 29 (8.92%) 20 (33.90%) 15 (19.74%) <0.001 * Smoking 33 (10.15%) 8 (13.56%) 11 (14.47%) 0.475 Alcohol 26 (8%) 7 (11.86%) 7 (9.21%) 0.616 *p value <0.05 Additional Declarations No competing interests reported. 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Therefore, its early detection is crucial. Currently, several countries employ fecal occult blood tests for the early detection of colorectal cancer. An individual with a positive fecal occult blood test is recommended to undergo further evaluation with a colonoscopy. The effectiveness of colon cleansing in colonoscopy is closely linked to the detection rate of polyps. Poor colon cleansing reduces the detection rate of colonic polyps, leading to an increased in the incidence of interval cancers and a simultaneous decrease in cancer detection rates [1-4]. Furthermore,\u0026nbsp;poor cleansing can extend the duration of colonoscopy, cause discomfort to the patient, increase the risk of complications, and unnecessary increase in healthcare costs [5-10]. Therefore, it is recommended that colon cleansing achieves \u003cu\u003e\u0026gt;\u003c/u\u003e90% visibility of the colonic surface in colonoscopy [11].\u003c/p\u003e\n\u003cp\u003eCurrently, several drugs exist that alter the osmotic pressure to enhance colon cleansing before a colonoscopy, which are often administered in multiple doses to improve the effectiveness [12-14]. However, a certain subset of patients, particularly those with schizophrenia respond less favorably to these drugs. Patients with schizophrenia often use antipsychotic medications, antidepressants, and antianxiety medications to manage their condition. Based on their pharmacological effects, antipsychotic and antidepressant medications decrease gastrointestinal motility, which can lead to constipation. The effectiveness of colon cleansing medications is decreased in these patients, making it challenging to detect colonic polyps [5-6]. Therefore, this study aimed to assess whether dietary modifications can enhance colon cleansing during colonoscopy, consequently increasing the detection rates of colonic polyps and colorectal cancer.\u003c/p\u003e"},{"header":"Patients And Method","content":"\u003cp\u003eThis retrospective study collected data from patients who underwent colonoscopies at our hospital from 2021 to September 2022. The exclusion criteria included patients \u0026lt;20 years old and those who underwent only sigmoidoscopy. Patients diagnosed with schizophrenia were defined by psychiatrists based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria [15].\u003c/p\u003e\n\u003cp\u003eThroughout the entire year of 2021, patients with schizophrenia and nonschizophrenic patients undergoing colonoscopy adhered to the same preparation regimen regarding dietary restrictions and dosage of bowel-cleansing medication. The precolonoscopy dietary preparation involved standard colonoscopy dietary protocol: a low-residue diet for the two days preceding and a clear liquid diet on the day before the procedure. The bowel preparation solution, polyethylene glycol (PEG), was administered on the evening of the day before and the morning of the day of the examination [16].\u003c/p\u003e\n\u003cp\u003eSince January 2022, patients with\u0026nbsp;schizophrenia\u0026nbsp;at our institute requiring colonoscopy examination were divided into a standard and diet-modified groups.\u0026nbsp;The standard group was initiated on a low-residue diet\u0026nbsp;two days before and a clean liquid diet the day before the colonoscopy examination. The diet-modified group was initiated on a low-residue diet four days before and a clean liquid diet two days before the colonoscopy examination. Nonschizophrenic patients undergoing colonoscopy followed a standard dietary preparation protocol, comprising a low-residue diet for the two days preceding the examination and a clear liquid diet the day before the procedure. The timing of administering the bowel-cleansing medication and PEG was consistent for the patients with schizophrenia and the nonschizophrenic patients, with the medication being administered on the evening before and the morning of the day of the examination.\u003c/p\u003e\n\u003cp\u003eWe used the Aronchick bowel preparation scale to evaluate the quality of bowel preparation, and the preparation quality of the entire colon was assessed as follows: 1, excellent (small volume of clear liquid or \u0026gt;95% of surface seen); 2, good (large volume of clear liquid covering 5%-25% of the surface but \u0026gt;90% of surface seen); 3, fair (some semisolid stool that could be suctioned or washed away but \u0026gt;90% of surface seen); 4, poor (semisolid stool that could not be suctioned or washed away and \u0026lt;90% of surface seen); 5, inadequate (repeat preparation and colonoscopy needed) [17].\u0026nbsp;The gastroenterologists\u0026nbsp;participating in the study have \u0026gt;5 years of experience in performing colonoscopies, and they have conducted \u0026gt;1500 colonoscopy procedures each.\u003c/p\u003e\n\u003cp\u003eAll statistical analyses were performed using the Statistical Packages for the Social Sciences (SPSS) Ver. 20.0 (IBM Corp., Armonk, NY, USA). Fisher\u0026rsquo;s exact test and the chi-square test were employed to compare the categorical variables. Student t-test was performed to compare the continuous variables. The statistical tests were two-sided, and the statistical significance was defined as p \u0026lt; 0.05.\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDuring the study period, in 2021, a total of 343 nonschizophrenic patients and 209 patients with schizophrenia underwent colonoscopy examinations. From January to September 2022, a total of 325 nonschizophrenic patients and 135 patients with schizophrenia underwent colonoscopy examinations. Among the patients with schizophrenia, 76 received dietary adjustments, whereas 59 followed the standard colonoscopy dietary protocol.\u0026nbsp;Table 1 listed the baseline patient characteristics.\u003c/p\u003e\n\u003cp\u003eIn 2021, among the nonschizophrenic patients who underwent colonoscopy, the colon cleansing effectiveness was as follows: Excellent: 148, good: 116, fair: 43, and poor: 36 cases. For patient with schizophrenia who underwent colonoscopy during the same period, the colon cleansing effectiveness was as follows: Excellent: 39, good: 39, fair: 59, and poor: 72 cases. The quality of bowel preparation was poor in 36/343 (10.50%) nonschizophrenic patients and 72/209 (34.45%) patients with schizophrenia in 2021 (p \u0026lt; 0.001). (Fig. 1)\u003c/p\u003e\n\u003cp\u003eFrom January 2022 to September 30, 2022, the quality of bowel preparation was poor in 25/325 (7.69%) nonschizophrenic patients and 32/135 (23.70%) patients with schizophrenia (p \u0026lt; 0.001). The quality of bowel preparation was poor in 20/59 (33.90%) patients of the standard group and 12/76 (15.79%) patients of the diet-modified group (p = 0.014). (Fig. 2)\u003c/p\u003e\n\u003cp\u003ePatients with schizophrenia and nonschizophrenic patients undergoing colonoscopy showed a similar incidence rate of colorectal cancer, with no statistically significant difference. (patients with schizophrenia 3/344 vs. nonschizophrenic patients 14/668, p = 0.151)\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe proportion of patients with schizophrenia in various countries is approximately 0.5%-1% of the total population [18]. However, in the town of Yuli in Taiwan, which serves as a chronic care community for patients with schizophrenia, individuals with schizophrenia live alongside\u0026nbsp;the\u0026nbsp;general population. Thus, the percentage of individuals with schizophrenia is quite high, currently accounting for approximately one-fourth of the population. Consequently, bowel cleansing is important for patients with schizophrenia before undergoing colonoscopy.\u003c/p\u003e\n\u003cp\u003ePrevious studies have shown that the use of antipsychotic medications can reduce the effectiveness of colon cleansing during colonoscopy [19]. This study observed that, during the year 2021, compared with nonschizophrenic patients, those with schizophrenia had significantly\u0026nbsp;poorer\u0026nbsp;colon cleansing. However, dietary adjustments conducted as part of the precolonoscopy preparation in 2022 showed that the effectiveness of colon cleansing significantly improved. Nevertheless, a notable difference in the effectiveness of colon cleansing existed when compared with nonschizophrenic patients.\u003c/p\u003e\n\u003cp\u003ePrevious research has indicated that, compared with nonschizophrenic patients, those with schizophrenia\u0026nbsp;possess\u0026nbsp;a higher incidence of colorectal cancer [20]. However, this trend was not observed in this study. There are two potential reasons for this discrepancy, which are as follows: 1. Exclusion of patients with poor colon cleansing: Patients with poor colon cleansing may have been excluded from the study, resulting in the inclusion of patients with advanced colorectal cancer, thereby skewing the results. 2. Delayed diagnosis or poor colonoscopy quality: Patients with schizophrenia might experience delays in diagnosis or suboptimal colonoscopy quality due to poor colon cleansing. This could lead to misdiagnosis or delayed detection of colorectal cancer, thereby contributing to an apparent decrease in colorectal cancer rates among these patients. The observed differences in colorectal cancer rates between patients with schizophrenia and nonschizophrenic patients in this study could be influenced by factors related to colon cleansing effectiveness, delayed diagnosis, or the quality of the colonoscopy procedures. Further research is needed to fully understand these factors and their impact on colorectal cancer rates in patients with schizophrenia.\u003c/p\u003e\n\u003cp\u003eThis study had some limitations. We were unable to investigate the correlation between the dosage and types of medications used for schizophrenia and the effectiveness of colon\u0026nbsp;cleansing. Among the included patients with schizophrenia, many of them had been on medication for several decades, and the types and dosages of medications might have gradually decreased gradually due to factors, such as cognitive decline, stroke, or aging. However, the impact of previous medications on the colon is often irreversible, leading to structural changes. Therefore, establishing a robust correlation between the types or dosages of medications and the current effectiveness of colonoscopy preparation is challenging. Furthermore, this study had a retrospective design, and future prospective studies are needed to provide more conclusive evidence.\u003c/p\u003e\n\u003cp\u003eIn conclusion, diet adjustment before colonoscopy can be used to improve the quality of bowel preparation in patients with schizophrenia.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of interest statement and financial support statement:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have and declare that: there are no other relationships or activities that could appear to have influenced the submitted work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study was no funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthic\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eApproval\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;and informed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe IRB of study was approved on Mar. 15, 2023 by Kaohsiung Veterans General Hospital. The IRB Number is KSVGH23-CT3-14. This is a retrospective study. The study has been granted exemption from ethics approval due to using irreversible anonymised data, so there is no informed consent. The research is conducted according to the principles of the Declaration of Helsinki.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMarmo R, Rotondano G, Riccio G, et al. Effective bowel cleansing before colonoscopy: a randomized study of split-dosage versus non-split dosage regimens of high-volume versus low- volume polyethylene glycol solutions. Gastrointest Endosc. 2010; 72:313\u0026ndash;320. https://doi.org/10.1016/j.gie.2010.02.048\u003c/li\u003e\n\u003cli\u003eLebwohl B, Kastrinos F, Glick M, et al. The impact of suboptimal bowel preparation on adenoma miss rates and the factors associated with early repeat colonoscopy. Gastrointest Endosc. 2011; 73:1207\u0026ndash;1214. https://doi.org/ 10.1016/j.gie.2011.01.051 \u003c/li\u003e\n\u003cli\u003eChokshi RV, Hovis CE, Hollander T, et al. Prevalence of missed adenomas in patients with inadequate bowel preparation on screening colonoscopy. Gastrointest Endosc. 2012; 75:1197\u0026ndash;1203. https://doi.org/10.1016/j.gie.2012.01.005\u003c/li\u003e\n\u003cli\u003eOh YS. What are we missing when colon preparation is inadequate? Gastrointestinal endoscopy. 2012; 75:1204\u0026ndash;1205. https://doi.org/10.1016/j.gie.2012.02.035\u003c/li\u003e\n\u003cli\u003eHassan C, Fuccio L, Bruno M, et al. A predictive model identifies patients most likely to have inadequate bowel preparation for colonoscopy. Clin Gastroenterol Hepatol. 2012; 10:501\u0026ndash;506. https://doi.org/10.1016/j.cgh.2011.12.037\u003c/li\u003e\n\u003cli\u003eLebwohl B, Wang TC, Neugut AI. Socioeconomic and other predictors of colonoscopy preparation quality. Dig Dis Sci. 2010; 55:2014\u0026ndash;2020. https://doi.org/10.1007/s10620-009-1079-7\u003c/li\u003e\n\u003cli\u003eBorg BB, Gupta NK, Zuckerman GR, et al. Impact of obesity on bowel preparation for colonoscopy. Clin Gastroenterol Hepatol. 2009; 7:670\u0026ndash;675. https://doi.org/10.1016/j.cgh.2009.02.014\u003c/li\u003e\n\u003cli\u003eCrispin A, Birkner B, Munte A, et al. Process quality and incidence of acute complications in a series of more than 230,000 outpatient colonoscopies. Endoscopy. 2009; 41:1018\u0026ndash;1025. https://doi.org/10.1055/s-0029-1215214\u003c/li\u003e\n\u003cli\u003eFroehlich F, Wietlisbach V, Gonvers JJ, et al. Impact of colonic cleansing on quality and diagnostic yield of colonoscopy: the European Panel of Appropriateness of Gastrointestinal Endoscopy European multicenter study. Gastrointest Endosc. 2005; 61:378\u0026ndash;384. https://doi.org/10.1016/s0016-5107(04)02776-2\u003c/li\u003e\n\u003cli\u003eRex DK, Imperiale TF, Latinovich DR, et al. Impact of bowel preparation on efficiency and cost of colonoscopy. Am J Gastroenterol. 2002; 97:1696\u0026ndash;1700. https://doi.org/10.1111/j.1572-241.2002.05827.x\u003c/li\u003e\n\u003cli\u003eJuluri R, Eckert G, Imperiale TF. Meta-analysis: randomized controlled trials of 4-L polyethylene glycol and sodium phosphate solution as bowel preparation for colonoscopy. \u003cem\u003eAliment Pharmacol Ther \u003c/em\u003e2010; 32: 171-181 https://doi.org/10.1111/j.1365-2036.2010.04326.x\u003c/li\u003e\n\u003cli\u003eDi Palma J, Rex D. Advances in bowel preparations: new formulation and clinical results. Gastroenterol Nurs. 2011; 34(Suppl 2):S2\u0026ndash;8. https://doi.org/10.1097/SGA.0b013e31823080ef\u003c/li\u003e\n\u003cli\u003eParente F, Marino B, Crosta C. Bowel preparation before colonoscopy in the era of mass screening for colo-rectal cancer: a practical approach. Dig Liver Dis. 2009; 41:87\u0026ndash;95. https://doi.org/10.1016/j.did.2008.06.005\u003c/li\u003e\n\u003cli\u003eMillien VO, Mansour NM. Bowel preparation for colonoscopy in 2020: A look at the Past, Present, and Future. Curr Gastroenterol Rep. 2020; 22 (6):28. https://doi.org/10.1007/s11894-020-00764-4\u003c/li\u003e\n\u003cli\u003eRajiv T, Wolfgang G, Deanna M, et al. Definition and description of schizophrenia in DSM-5. Schizophrenia Research 2013;150:3-10. https://doi.org/10.1016/j.schres.2013.05.028\u003c/li\u003e\n\u003cli\u003eAlawi S, Dhahab H, Salmi I. Split dose bowel preparation before colonoscopy of PEG (Nulytely) in comparison to routine single dose bowel preparation. Saudi Journal of Gastroenterology 2021; 27(4): 234-239. https://doi.org/10.4103/sjg.sjg_563_20\u003c/li\u003e\n\u003cli\u003eAronchick CA, Lipshutz WH, Wright SH, Dufrayne F, Bergman G. Validation of an instrument to assess colon cleansing [abstract]. Am J Gastroenterol 1999;94:2667. \u003c/li\u003e\n\u003cli\u003eJauhar S, Johnstone M, McKenna PJ. Schizophrenia. Lancet. 2022; 399: 473-486. https://doi.org/10.1016/S0140-6736(21)01730-X\u003c/li\u003e\n\u003cli\u003eVladimir MK, Pavan B, Reena VC, et al. The Impact of opiate pain medications and psychoactive drugs on the quality of colon preparation in outpatient colonoscopy. Dig Liver Dis. 2014; 46(1): 56-61. https://doi.org/10.1016/j.did.2013.07.020\u003c/li\u003e\n\u003cli\u003eJulia HC, Yana V, Carol C, et al. Risk of Malignancy in Patients With Schizophrenia or Bipolar Disorder. Arch Gen Psychiatry 2007; 64(12): 1368-1376. https://doi.org/10.1001/archpsyc.64.12.1368\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Demographic information of patient receiving colonoscopy in 2021 and 2022\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e2021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.688969258589513%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.43399638336347%\" valign=\"top\"\u003e\n \u003cp\u003eNon-schizophrenic patient group\u003c/p\u003e\n \u003cp\u003e(N = 343)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.30379746835443%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePatient with schizophrenia group\u003c/p\u003e\n \u003cp\u003e(N = 209)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.573236889692586%\" valign=\"top\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.688969258589513%\" valign=\"top\"\u003e\n \u003cp\u003eSex (M)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.43399638336347%\" valign=\"top\"\u003e\n \u003cp\u003e193 (56.27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.30379746835443%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e135 (64.59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.573236889692586%\" valign=\"top\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.688969258589513%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.43399638336347%\" valign=\"top\"\u003e\n \u003cp\u003e59.91 (15.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.30379746835443%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e62.03 (12.38)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.573236889692586%\" valign=\"top\"\u003e\n \u003cp\u003e0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.688969258589513%\" valign=\"top\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.43399638336347%\" valign=\"top\"\u003e\n \u003cp\u003e75 (21.87%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.30379746835443%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e88 (42.11%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.573236889692586%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.688969258589513%\" valign=\"top\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.43399638336347%\" valign=\"top\"\u003e\n \u003cp\u003e49 (14.29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.30379746835443%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e41 (19.62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.573236889692586%\" valign=\"top\"\u003e\n \u003cp\u003e0.100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.688969258589513%\" valign=\"top\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.43399638336347%\" valign=\"top\"\u003e\n \u003cp\u003e71 (20.70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.30379746835443%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e36 (17.22%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.573236889692586%\" valign=\"top\"\u003e\n \u003cp\u003e0.316\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.688969258589513%\" valign=\"top\"\u003e\n \u003cp\u003eAlcohol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.43399638336347%\" valign=\"top\"\u003e\n \u003cp\u003e39 (11.37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"44.30379746835443%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e17 (8.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.573236889692586%\" valign=\"top\"\u003e\n \u003cp\u003e0.382\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e2022\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.731884057971016%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.471014492753625%\" valign=\"top\"\u003e\n \u003cp\u003eNon-schizophrenic patient group\u003c/p\u003e\n \u003cp\u003e(N = 325)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.10144927536232%\" valign=\"top\"\u003e\n \u003cp\u003ePatient with schizophrenia standard group\u003c/p\u003e\n \u003cp\u003e(N = 59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.10144927536232%\" valign=\"top\"\u003e\n \u003cp\u003ePatient with Schizophrenia diet-modified group (N = 76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.594202898550725%\" valign=\"top\"\u003e\n \u003cp\u003ep value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.731884057971016%\" valign=\"top\"\u003e\n \u003cp\u003eSex (M)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.471014492753625%\" valign=\"top\"\u003e\n \u003cp\u003e175 (53.85%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.10144927536232%\" valign=\"top\"\u003e\n \u003cp\u003e33 (55.93%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.10144927536232%\" valign=\"top\"\u003e\n \u003cp\u003e47 (61.84%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.594202898550725%\" valign=\"top\"\u003e\n \u003cp\u003e0.449\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.731884057971016%\" valign=\"top\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.471014492753625%\" valign=\"top\"\u003e\n \u003cp\u003e60.89 (14.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.10144927536232%\" valign=\"top\"\u003e\n \u003cp\u003e61.07 (12.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.10144927536232%\" valign=\"top\"\u003e\n \u003cp\u003e59.02 (11.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.594202898550725%\" valign=\"top\"\u003e\n \u003cp\u003e0.527\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.731884057971016%\" valign=\"top\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.471014492753625%\" valign=\"top\"\u003e\n \u003cp\u003e57 (17.54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.10144927536232%\" valign=\"top\"\u003e\n \u003cp\u003e26 (44.07%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.10144927536232%\" valign=\"top\"\u003e\n \u003cp\u003e23 (30.26%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.594202898550725%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.731884057971016%\" valign=\"top\"\u003e\n \u003cp\u003eDiabetes mellitus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.471014492753625%\" valign=\"top\"\u003e\n \u003cp\u003e29 (8.92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.10144927536232%\" valign=\"top\"\u003e\n \u003cp\u003e20 (33.90%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.10144927536232%\" valign=\"top\"\u003e\n \u003cp\u003e15 (19.74%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.594202898550725%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.731884057971016%\" valign=\"top\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.471014492753625%\" valign=\"top\"\u003e\n \u003cp\u003e33 (10.15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.10144927536232%\" valign=\"top\"\u003e\n \u003cp\u003e8 (13.56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.10144927536232%\" valign=\"top\"\u003e\n \u003cp\u003e11 (14.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.594202898550725%\" valign=\"top\"\u003e\n \u003cp\u003e0.475\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.731884057971016%\" valign=\"top\"\u003e\n \u003cp\u003eAlcohol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.471014492753625%\" valign=\"top\"\u003e\n \u003cp\u003e26 (8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.10144927536232%\" valign=\"top\"\u003e\n \u003cp\u003e7 (11.86%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.10144927536232%\" valign=\"top\"\u003e\n \u003cp\u003e7 (9.21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.594202898550725%\" valign=\"top\"\u003e\n \u003cp\u003e0.616\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*p value \u0026lt;0.05\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"colonoscopy prepare, schizophrenia, diet adjustment","lastPublishedDoi":"10.21203/rs.3.rs-4217392/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4217392/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Quality of bowel preparation is crucial in colonoscopy. However, patients with schizophrenia are prescribed antipsychotic medicines, which may influence the effect of bowel preparation for colonoscopy. Poor quality of bowel preparation can reduce the benefit of colonoscopy, and increase the risk of overlooking possible colorectal cancers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim: \u003c/strong\u003eThis study aimed to employ diet adjustment before colonoscopy to improve the quality of bowel preparation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003c/strong\u003e Since January 2022, patients with schizophrenia at our institute requiring colonoscopy examination were divided into a standard group and a diet-modified groups. The standard group was initiated with a low-residue diet two days before and a clean liquid diet the day before the colonoscopy examination. The diet-modified group was initiated with a low-residue diet four days before and a clean liquid diet two days before the colonoscopy examination. Both groups were administered bowel cleansing medicines the day before and the morning of the examination. We used the Aronchick bowel preparation scale to evaluate the quality of bowel preparation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult:\u003c/strong\u003e From January 2022 to September 30, 2022, the quality of bowel preparation was poor in 25/325 (7.69%) non-schizophrenic patients and 32/135 (23.70%) patients with schizophrenia (p \u0026lt; 0.001). The quality of bowel preparation was poor in 20/59 (33.90%) and 12/76 (15.79%) patients of the standard and the diet-modified groups, respectively (p = 0.014).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Diet adjustment before colonoscopy can be used to improve the quality of bowel preparation in patients with schizophrenia.\u003c/p\u003e","manuscriptTitle":"Diet Adjustment Before Colonoscopy Can Improve the Quality of Bowel Preparation in Patients with Schizophrenia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-11 18:09:13","doi":"10.21203/rs.3.rs-4217392/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6c1f158d-83dd-49c1-9993-276d1a9b89cd","owner":[],"postedDate":"April 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-01T18:53:37+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-11 18:09:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4217392","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4217392","identity":"rs-4217392","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}