Disparities in bowel preparation quality for colonoscopy in Central Australia: A retrospective cohort study at Alice Springs Hospital

Disparities in bowel preparation quality for colonoscopy in Central Australia: A retrospective cohort study at Alice Springs Hospital | 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 Disparities in bowel preparation quality for colonoscopy in Central Australia: A retrospective cohort study at Alice Springs Hospital Vardhaman Gowda, Sanjeevi Rajesh, Aung Myint Htay Htay This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9067071/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background High-quality bowel preparation is essential for accurate and safe colonoscopy. Demographic, medical, and socio-cultural factors may influence bowel preparation adequacy, particularly in regional and remote populations in Central Australia. Methods A retrospective cohort study was conducted on consecutive colonoscopies performed between March and August 2025 at Alice Springs Hospital. The primary outcome was mean Boston Bowel Preparation Scale (BBPS) score. Secondary outcomes included predictors of inadequate bowel preparation (BBPS < 6) using multivariable logistic regression. Results A total of 125 colonoscopies were included (35 First Nations and 90 non–First Nations patients). Mean BBPS was significantly lower among First Nations patients (6.0 ± 1.8 vs 7.8 ± 1.6; p < 0.001). Inadequate bowel preparation occurred in 28.6% of First Nations patients and 7.8% of non–First Nations patients (p = 0.002). Independent predictors of inadequate preparation included First Nations status, inpatient status, chronic kidney disease, travel distance greater than 200 km, and hospital-based preparation. Conclusion First Nations patients were significantly more likely to experience inadequate bowel preparation for colonoscopy. Addressing communication barriers, logistical challenges, and culturally appropriate education may improve preparation quality in remote healthcare settings. Clinical Trial Registration Not applicable. Colonoscopy bowel preparation Boston Bowel Preparation Scale First Nations health rural health healthcare disparities Australia Background Adequate bowel preparation is critical for high-quality colonoscopy, as it directly influences caecal intubation rates, adenoma detection, and diagnostic accuracy. Inadequate preparation increases procedural time, cost, and complication risk, while reducing the effectiveness of screening and surveillance. Previous studies have identified predictors of poor bowel preparation, including older age, inpatient status, comorbidities, and communication barriers. Language differences and health literacy may further affect adherence to preparation instructions. International guidelines emphasise adequate bowel cleansing to optimise diagnostic yield. Central Australia presents unique healthcare challenges. A substantial proportion of the population identifies as Aboriginal or Torres Strait Islander (First Nations), many living in remote communities located hundreds of kilometres from tertiary centres. Geographic isolation, multilingualism, cultural differences in communication, and travel logistics may affect bowel preparation quality. This study aimed to evaluate bowel preparation quality among patients undergoing colonoscopy at Alice Springs Hospital and to identify demographic, clinical, and logistical predictors of inadequate preparation. Methods Study Design and Setting This retrospective cohort study was conducted at Alice Springs Hospital, a regional referral centre serving a large remote catchment in Central Australia. Colonoscopies performed between March and August 2025 were included. Participants All patients undergoing colonoscopy with documented BBPS scores were included. Exclusion criteria were incomplete procedures, missing BBPS documentation, or cognitive impairment affecting adherence to preparation instructions. Data Collection Data were obtained from questionnaire we used, electronic medical records, endoscopy reports, and hospital databases. Variables included: Demographic: age, sex, First Nations status Clinical: diabetes, chronic kidney disease (CKD), ischaemic heart disease, hypertension, inpatient status Procedural: BBPS score, prior colonoscopy, preparation location Logistical: travel distance (> 200 km vs ≤ 200 km), interpreter involvement, Aboriginal Liaison Officer involvement Outcomes Primary outcome: mean BBPS score Secondary outcomes: Proportion of inadequate bowel preparation (BBPS < 6) Predictors of inadequate bowel preparation Statistical Analysis Continuous variables were compared using Welch’s t-test. Categorical variables were analysed using chi-square or Fisher’s exact tests as appropriate. Variables with p < 0.10 in univariate analysis were included in multivariable logistic regression. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. Statistical significance was defined as p < 0.05. Results Cohort Characteristics A total of 125 patients were included, of whom 35 (28%) identified as First Nations. First Nations patients had higher rates of diabetes and chronic kidney disease and were more frequently inpatients at the time of colonoscopy. Bowel Preparation Quality Mean BBPS was significantly lower among First Nations patients compared with non–First Nations patients (6.0 ± 1.8 vs 7.8 ± 1.6; p < 0.001). Inadequate bowel preparation (BBPS < 6) occurred in: 28.6% of First Nations patients 7.8% of non–First Nations patients Table 1 Baseline Characteristics Characteristic First Nations (n = 35) Non–First Nations (n = 90) Mean age (years) 59.2 57.8 Female sex, n (%) 20 (57%) 51 (57%) Inpatient status, n (%) 10 (29%) 9 (10%) Diabetes, n (%) 24 (68%) 29 (32%) CKD, n (%) 10 (29%) 8 (9%) Mean BBPS (SD) 6.0 (1.8) 7.8 (1.6) Inadequate BBPS (< 6), n (%) 10 (28.6%) 7 (7.8%) Table 2 Multivariable Predictors of Inadequate Bowel Preparation Predictor Adjusted OR (95% CI) p-value First Nations status 4.8 (1.8–12.7) 0.001 Inpatient status 3.9 (1.4–10.6) 0.007 CKD (≥ Stage 3) 3.2 (1.1–9.3) 0.035 Distance > 200 km 2.7 (1.0–7.4) 0.049 Hospital-based preparation 2.9 (1.0–8.3) 0.046 Comorbidities Patients with two or more comorbidities had a significantly higher risk of inadequate bowel preparation. Diabetes showed a non-significant trend toward poorer preparation. Table 3 Association Between Comorbidities and Inadequate Bowel Preparation Comorbidity % Inadequate Prep Odds Ratio (95% CI) p-value Interpretation Diabetes Mellitus 22.0% vs 10.5% 2.3 (0.9–5.9) 0.08 Trend CKD (≥ Stage 3) 28.6% vs 9.5% 3.2 (1.1–9.3) 0.035 Significant Hypertension 18.0% vs 12.5% 1.5 (0.6–3.8) 0.32 Not significant Cardiovascular Disease 20.0% vs 12.3% 1.8 (0.7–4.9) 0.21 Not significant ≥ 2 Comorbidities 26.3% vs 9.8% 2.9 (1.0–8.1) 0.048 Significant Discussion This study demonstrates a significant disparity in bowel preparation quality between First Nations and non–First Nations patients undergoing colonoscopy in Central Australia. First Nations patients were nearly five times more likely to have inadequate bowel preparation after adjusting for clinical and logistical factors. Travel burden is a key contributor, as many patients reside in remote communities more than 200 km from the hospital. Travel logistics may disrupt preparation timing and dietary adherence. Communication barriers are also important. Many First Nations patients speak English as a second or third language, and documentation of interpreter or Aboriginal Liaison Officer involvement was inconsistent. Medical complexity further contributed to poorer outcomes. Chronic kidney disease and inpatient status were independent predictors, likely reflecting both physiological factors and hospital-related logistical challenges. Hospital-based bowel preparation was associated with poorer outcomes, suggesting variability in staff instruction, patient mobility, and timing. These findings are consistent with prior studies identifying inpatient status and comorbidities as risk factors for inadequate bowel preparation. Conclusions First Nations patients undergoing colonoscopy at Alice Springs Hospital are significantly more likely to experience inadequate bowel preparation. Addressing these disparities requires culturally appropriate education, improved communication, structured inpatient preparation protocols, and logistical support for patients travelling from remote communities. Declarations Ethics Approval and Consent to Participate This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Northern Territory Human Research Ethics Committee (NT Department of Health and Menzies School of Health Research). The requirement for individual consent was waived due to the retrospective use of de-identified data. Consent for Publication: Not applicable. Funding: No specific funding was received. Clinical Trial Number: Not applicable. Author Contribution Manuscript TitleDisparities in bowel preparation quality in a remote Australian hospital: A retrospective cohort study from Central Australia________________________________________AuthorsDr Vardhaman A. P. Gowda, MBBS, DUEG MBAPrincipal InvestigatorAlice Springs Hospital, NT, AustraliaDr Rajesh Sanjeevi, MD, DM, FRACPAlice Springs Hospital, NT, AustraliaDr Aung Myint Htay, MBBSAlice Springs Hospital, NT, Australia________________________________________Institutional AffiliationGastroenterologyDepartment of MedicineAlice Springs HospitalNorthern Territory, Australia________________________________________Corresponding AuthorDr Vardhaman A. P. GowdaGastroenterologyDepartment of MedicineAlice Springs HospitalNorthern Territory, AustraliaEmail: [email protected] ________________________________________Author ContributionsDr Vardhaman A. P. Gowda conceived the study, collected data, performed statistical analysis and drafted the manuscript.Dr Rajesh Sanjeevi contributed to study design, interpretation of results and manuscript revision.Dr Aung Myint Htay contributed to data collection and manuscript revision.All authors approved the final manuscript.________________________________________Conflict of Interest StatementThe authors declare no conflicts of interest.________________________________________FundingNo external funding was received for this study.________________________________________Ethics Statement This study was conducted as a low-risk clinical audit and was submitted to the Northern Territory Human Research Ethics Committee (NT HREC; NT Department of Health and Menzies School of Health Research) in accordance with local governance requirements. The audit notification process was completed by the investigators. All data were de-identified prior to analysis and stored on secure NT Health servers. Consultation regarding publication was undertaken with the Aboriginal Liaison Officer at Alice Springs Hospital. Acknowledgement This study was conducted as a low-risk clinical audit and was submitted to the Northern Territory Human Research Ethics Committee (NT HREC; NT Department of Health and Menzies School of Health Research) in accordance with local governance requirements. The audit notification process was completed by the investigators. All data were de-identified prior to analysis and stored on secure NT Health servers. Consultation regarding publication was undertaken with the Aboriginal Liaison Officer at Alice Springs Hospital. Special thanks to endoscopy unit nurses, theater staff and theatre schedulers at Alice Springs hospital. Data Availability Data are available from the corresponding author on reasonable request. References Blaney H, et al. Evaluation of language disparity in adequacy of bowel preparation for colonoscopy. Gastro Hep Adv. 2025;4(6):100637. Winrich E, et al. Medical and social risk factors for inadequate bowel preparation prior to colonoscopy. J Gastroenterol Hepatol Res. 2023;3:1127. Siersema PD. Which patient-related factors determine optimal bowel preparation? Endoscopy. 2018;16:406–16. Australian Commission on Safety and Quality in Health Care. Colonoscopy for Aboriginal and Torres Strait Islander Peoples – Fact Sheet. 2024. Johnson DA, et al. Optimising adequacy of bowel cleansing for colonoscopy. Gastroenterology. 2014;147:903–24. Additional Declarations No competing interests reported. Supplementary Files BowelPrepStudytablesandgraphs..docx QuestionnaireBowelprepstudy..docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 23 Apr, 2026 Editor assigned by journal 20 Apr, 2026 Editor invited by journal 30 Mar, 2026 Submission checks completed at journal 28 Mar, 2026 First submitted to journal 28 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9067071","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":633551394,"identity":"d6d40076-fd4e-4e63-a06b-2fb73018fb3c","order_by":0,"name":"Vardhaman Gowda","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYDCCA3BWDpiUY2DgIaiFsQFZizHpWhIbCGnhO978/MHHPYflzdtzD366UXMnfcPxswcffGCwk9NtwK5F8swxw8YZzw4bzjnzLlk659iz3A1n8pINZzAkG5sdwK7F4EYOYzPPgTTGGRI5BtI5bIdzNxzIMZPmYTiQuI2AFnugFuPfOf8Opxucf0OUFptEoBYz6dy2wwlAEfxaQH6ZOeOATfIMnjdm1rl9hw1n3nhjbDjDALdfgCH24MOHAxK2M9hzjG/nfDssz3c+x/DBhwo7OVxaMIECWKUBscpBQL6BFNWjYBSMglEwEgAAL7Vm3GjKmncAAAAASUVORK5CYII=","orcid":"","institution":"Alice Springs Hospital","correspondingAuthor":true,"prefix":"","firstName":"Vardhaman","middleName":"","lastName":"Gowda","suffix":""},{"id":633551395,"identity":"14cd75ee-79ce-4417-ba28-6911090e5864","order_by":1,"name":"Sanjeevi Rajesh","email":"","orcid":"","institution":"Alice Springs Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sanjeevi","middleName":"","lastName":"Rajesh","suffix":""},{"id":633551396,"identity":"938652d3-0734-4e08-a633-08677f4f8a22","order_by":2,"name":"Aung Myint Htay Htay","email":"","orcid":"","institution":"Alice Springs Hospital","correspondingAuthor":false,"prefix":"","firstName":"Aung","middleName":"Myint Htay","lastName":"Htay","suffix":""}],"badges":[],"createdAt":"2026-03-09 00:53:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9067071/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9067071/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108809212,"identity":"009d7113-ce05-495d-8256-ee0799c46d7f","added_by":"auto","created_at":"2026-05-08 15:50:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":167764,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9067071/v1/c31178ed-6463-4d50-8d6f-a311b8f37d3b.pdf"},{"id":108393991,"identity":"d6e53979-f69f-4425-8249-f09ac5ff8150","added_by":"auto","created_at":"2026-05-04 07:34:53","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1112481,"visible":true,"origin":"","legend":"","description":"","filename":"BowelPrepStudytablesandgraphs..docx","url":"https://assets-eu.researchsquare.com/files/rs-9067071/v1/fd41df893625807336a16291.docx"},{"id":108804158,"identity":"35ca4faf-044b-49ee-b0cc-373d9c3735e4","added_by":"auto","created_at":"2026-05-08 15:16:49","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":16568,"visible":true,"origin":"","legend":"","description":"","filename":"QuestionnaireBowelprepstudy..docx","url":"https://assets-eu.researchsquare.com/files/rs-9067071/v1/0177200c6316ca63085510e4.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Disparities in bowel preparation quality for colonoscopy in Central Australia: A retrospective cohort study at Alice Springs Hospital","fulltext":[{"header":"Background","content":"\u003cp\u003eAdequate bowel preparation is critical for high-quality colonoscopy, as it directly influences caecal intubation rates, adenoma detection, and diagnostic accuracy. Inadequate preparation increases procedural time, cost, and complication risk, while reducing the effectiveness of screening and surveillance.\u003c/p\u003e \u003cp\u003ePrevious studies have identified predictors of poor bowel preparation, including older age, inpatient status, comorbidities, and communication barriers. Language differences and health literacy may further affect adherence to preparation instructions. International guidelines emphasise adequate bowel cleansing to optimise diagnostic yield.\u003c/p\u003e \u003cp\u003eCentral Australia presents unique healthcare challenges. A substantial proportion of the population identifies as Aboriginal or Torres Strait Islander (First Nations), many living in remote communities located hundreds of kilometres from tertiary centres. Geographic isolation, multilingualism, cultural differences in communication, and travel logistics may affect bowel preparation quality.\u003c/p\u003e \u003cp\u003eThis study aimed to evaluate bowel preparation quality among patients undergoing colonoscopy at Alice Springs Hospital and to identify demographic, clinical, and logistical predictors of inadequate preparation.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy Design and Setting\u003c/p\u003e\u003cp\u003eThis retrospective cohort study was conducted at Alice Springs Hospital, a regional referral centre serving a large remote catchment in Central Australia. Colonoscopies performed between March and August 2025 were included.\u003c/p\u003e\u003cp\u003eParticipants\u003c/p\u003e\u003cp\u003eAll patients undergoing colonoscopy with documented BBPS scores were included. Exclusion criteria were incomplete procedures, missing BBPS documentation, or cognitive impairment affecting adherence to preparation instructions.\u003c/p\u003e\u003cp\u003eData Collection\u003c/p\u003e\u003cp\u003eData were obtained from questionnaire we used, electronic medical records, endoscopy reports, and hospital databases. Variables included:\u003c/p\u003e\u003cul\u003e \u003cli\u003e \u003cp\u003eDemographic: age, sex, First Nations status\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eClinical: diabetes, chronic kidney disease (CKD), ischaemic heart disease, hypertension, inpatient status\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eProcedural: BBPS score, prior colonoscopy, preparation location\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eLogistical: travel distance (\u0026gt; 200 km vs ≤ 200 km), interpreter involvement, Aboriginal Liaison Officer involvement\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e\u003cp\u003eOutcomes\u003c/p\u003e\u003cp\u003ePrimary outcome: mean BBPS score\u003c/p\u003e\u003cp\u003eSecondary outcomes:\u003c/p\u003e\u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eProportion of inadequate bowel preparation (BBPS \u0026lt; 6)\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePredictors of inadequate bowel preparation\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eContinuous variables were compared using Welch’s t-test. Categorical variables were analysed using chi-square or Fisher’s exact tests as appropriate. Variables with p \u0026lt; 0.10 in univariate analysis were included in multivariable logistic regression. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. Statistical significance was defined as p \u0026lt; 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eCohort Characteristics\u003c/p\u003e \u003cp\u003eA total of 125 patients were included, of whom 35 (28%) identified as First Nations. First Nations patients had higher rates of diabetes and chronic kidney disease and were more frequently inpatients at the time of colonoscopy.\u003c/p\u003e \u003cp\u003eBowel Preparation Quality\u003c/p\u003e \u003cp\u003eMean BBPS was significantly lower among First Nations patients compared with non\u0026ndash;First Nations patients (6.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 vs 7.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eInadequate bowel preparation (BBPS\u0026thinsp;\u0026lt;\u0026thinsp;6) occurred in:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e28.6% of First Nations patients\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e7.8% of non\u0026ndash;First Nations patients\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFirst Nations (n\u0026thinsp;=\u0026thinsp;35)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon\u0026ndash;First Nations (n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale sex, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (57%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (57%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInpatient status, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (10%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (68%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (32%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKD, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean BBPS (SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.0 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.8 (1.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInadequate BBPS (\u0026lt;\u0026thinsp;6), n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (7.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariable Predictors of Inadequate Bowel Preparation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePredictor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdjusted OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst Nations status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.8 (1.8\u0026ndash;12.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInpatient status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.9 (1.4\u0026ndash;10.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKD (\u0026ge;\u0026thinsp;Stage 3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.2 (1.1\u0026ndash;9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistance\u0026thinsp;\u0026gt;\u0026thinsp;200 km\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.7 (1.0\u0026ndash;7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital-based preparation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.9 (1.0\u0026ndash;8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eComorbidities\u003c/p\u003e \u003cp\u003ePatients with two or more comorbidities had a significantly higher risk of inadequate bowel preparation. Diabetes showed a non-significant trend toward poorer preparation.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation Between Comorbidities and Inadequate Bowel Preparation\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e% Inadequate Prep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOdds Ratio (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eInterpretation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes Mellitus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.0% vs 10.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.3 (0.9\u0026ndash;5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTrend\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKD (\u0026ge;\u0026thinsp;Stage 3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.6% vs 9.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.2 (1.1\u0026ndash;9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.0% vs 12.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.5 (0.6\u0026ndash;3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCardiovascular Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.0% vs 12.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.8 (0.7\u0026ndash;4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNot significant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2 Comorbidities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26.3% vs 9.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.9 (1.0\u0026ndash;8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSignificant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study demonstrates a significant disparity in bowel preparation quality between First Nations and non\u0026ndash;First Nations patients undergoing colonoscopy in Central Australia. First Nations patients were nearly five times more likely to have inadequate bowel preparation after adjusting for clinical and logistical factors.\u003c/p\u003e \u003cp\u003eTravel burden is a key contributor, as many patients reside in remote communities more than 200 km from the hospital. Travel logistics may disrupt preparation timing and dietary adherence.\u003c/p\u003e \u003cp\u003eCommunication barriers are also important. Many First Nations patients speak English as a second or third language, and documentation of interpreter or Aboriginal Liaison Officer involvement was inconsistent.\u003c/p\u003e \u003cp\u003eMedical complexity further contributed to poorer outcomes. Chronic kidney disease and inpatient status were independent predictors, likely reflecting both physiological factors and hospital-related logistical challenges.\u003c/p\u003e \u003cp\u003eHospital-based bowel preparation was associated with poorer outcomes, suggesting variability in staff instruction, patient mobility, and timing.\u003c/p\u003e \u003cp\u003eThese findings are consistent with prior studies identifying inpatient status and comorbidities as risk factors for inadequate bowel preparation.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eFirst Nations patients undergoing colonoscopy at Alice Springs Hospital are significantly more likely to experience inadequate bowel preparation. Addressing these disparities requires culturally appropriate education, improved communication, structured inpatient preparation protocols, and logistical support for patients travelling from remote communities.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e \u003cp\u003e This study was conducted in accordance with the Declaration of Helsinki. Ethical approval was obtained from the Northern Territory Human Research Ethics Committee (NT Department of Health and Menzies School of Health Research). The requirement for individual consent was waived due to the retrospective use of de-identified data.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for Publication:\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eNo specific funding was received.\u003c/p\u003e \u003cp\u003eClinical Trial Number: Not applicable.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eManuscript TitleDisparities in bowel preparation quality in a remote Australian hospital: A retrospective cohort study from Central Australia________________________________________AuthorsDr Vardhaman A. P. Gowda, MBBS, DUEG MBAPrincipal InvestigatorAlice Springs Hospital, NT, AustraliaDr Rajesh Sanjeevi, MD, DM, FRACPAlice Springs Hospital, NT, AustraliaDr Aung Myint Htay, MBBSAlice Springs Hospital, NT, Australia________________________________________Institutional AffiliationGastroenterologyDepartment of MedicineAlice Springs HospitalNorthern Territory, Australia________________________________________Corresponding AuthorDr Vardhaman A. P. GowdaGastroenterologyDepartment of MedicineAlice Springs HospitalNorthern Territory, AustraliaEmail: [email protected]________________________________________Author ContributionsDr Vardhaman A. P. Gowda conceived the study, collected data, performed statistical analysis and drafted the manuscript.Dr Rajesh Sanjeevi contributed to study design, interpretation of results and manuscript revision.Dr Aung Myint Htay contributed to data collection and manuscript revision.All authors approved the final manuscript.________________________________________Conflict of Interest StatementThe authors declare no conflicts of interest.________________________________________FundingNo external funding was received for this study.________________________________________Ethics Statement This study was conducted as a low-risk clinical audit and was submitted to the Northern Territory Human Research Ethics Committee (NT HREC; NT Department of Health and Menzies School of Health Research) in accordance with local governance requirements. The audit notification process was completed by the investigators. All data were de-identified prior to analysis and stored on secure NT Health servers. Consultation regarding publication was undertaken with the Aboriginal Liaison Officer at Alice Springs Hospital.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThis study was conducted as a low-risk clinical audit and was submitted to the Northern Territory Human Research Ethics Committee (NT HREC; NT Department of Health and Menzies School of Health Research) in accordance with local governance requirements. The audit notification process was completed by the investigators. All data were de-identified prior to analysis and stored on secure NT Health servers. Consultation regarding publication was undertaken with the Aboriginal Liaison Officer at Alice Springs Hospital. Special thanks to endoscopy unit nurses, theater staff and theatre schedulers at Alice Springs hospital.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBlaney H, et al. Evaluation of language disparity in adequacy of bowel preparation for colonoscopy. Gastro Hep Adv. 2025;4(6):100637.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWinrich E, et al. Medical and social risk factors for inadequate bowel preparation prior to colonoscopy. J Gastroenterol Hepatol Res. 2023;3:1127.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSiersema PD. Which patient-related factors determine optimal bowel preparation? Endoscopy. 2018;16:406\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAustralian Commission on Safety and Quality in Health Care. Colonoscopy for Aboriginal and Torres Strait Islander Peoples \u0026ndash; Fact Sheet. 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJohnson DA, et al. Optimising adequacy of bowel cleansing for colonoscopy. Gastroenterology. 2014;147:903\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"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":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Colonoscopy, bowel preparation, Boston Bowel Preparation Scale, First Nations health, rural health, healthcare disparities, Australia","lastPublishedDoi":"10.21203/rs.3.rs-9067071/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9067071/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHigh-quality bowel preparation is essential for accurate and safe colonoscopy. Demographic, medical, and socio-cultural factors may influence bowel preparation adequacy, particularly in regional and remote populations in Central Australia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective cohort study was conducted on consecutive colonoscopies performed between March and August 2025 at Alice Springs Hospital. The primary outcome was mean Boston Bowel Preparation Scale (BBPS) score. Secondary outcomes included predictors of inadequate bowel preparation (BBPS\u0026thinsp;\u0026lt;\u0026thinsp;6) using multivariable logistic regression.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 125 colonoscopies were included (35 First Nations and 90 non\u0026ndash;First Nations patients). Mean BBPS was significantly lower among First Nations patients (6.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 vs 7.8\u0026thinsp;\u0026plusmn;\u0026thinsp;1.6; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Inadequate bowel preparation occurred in 28.6% of First Nations patients and 7.8% of non\u0026ndash;First Nations patients (p\u0026thinsp;=\u0026thinsp;0.002). Independent predictors of inadequate preparation included First Nations status, inpatient status, chronic kidney disease, travel distance greater than 200 km, and hospital-based preparation.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eFirst Nations patients were significantly more likely to experience inadequate bowel preparation for colonoscopy. Addressing communication barriers, logistical challenges, and culturally appropriate education may improve preparation quality in remote healthcare settings.\u003c/p\u003e\u003ch2\u003eClinical Trial Registration\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e","manuscriptTitle":"Disparities in bowel preparation quality for colonoscopy in Central Australia: A retrospective cohort study at Alice Springs Hospital","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-04 07:34:45","doi":"10.21203/rs.3.rs-9067071/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2026-04-23T07:59:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-20T08:18:32+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-30T09:37:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-28T13:27:01+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Gastroenterology","date":"2026-03-28T13:23:19+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-gastroenterology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmge","sideBox":"Learn more about [BMC Gastroenterology](http://bmcgastroenterol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmge/default.aspx","title":"BMC Gastroenterology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0dbb9d0f-d4db-4b6e-95fe-330d7049c14b","owner":[],"postedDate":"May 4th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T07:34:45+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-04 07:34:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9067071","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9067071","identity":"rs-9067071","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}