Intestinal Biofilms and Laxatives: Efficacy of Oral Sulfate Solution in Combination with Linaclotide for Pre-colonoscopy Bowel Preparation

Aims: The present study endeavors to explore the effectiveness of a combined regimen of an oral sulfate solution (OSS) and linaclotide in bowel preparation, while also delving into the influence of intestinal biofilms on the resultant quality of bowel preparation. Methods: From September 2023 to February 2024, a total of 444 eligible participants were recruited and randomly assigned to one of three groups: the OSS + Linaclotide group, the OSS group, and the Polyethylene glycol (PEG) group. The primary outcome was evaluated using the Boston Bowel Preparation Scale (BBPS) to assess the efficacy of bowel cleansing. Tolerability was determined based on the incidence and severity of adverse events. Additionally, the presence and impact of intestinal biofilms on the quality of bowel preparation were assessed through endoscopic examination. Result: A total of 400 cases were analyzed. The results revealed that both the OSS + Linaclotide and OSS groups achieved comparable, superior intestinal cleansing quality compared to the traditional PEG group (86.0% vs. 87.1% vs. 72.8%, respectively, p = 0.004). Notably, the OSS + Linaclotide group experienced a reduced incidence of abdominal distension. In this study, intestinal biofilms were detected in 30% of cases (120/400). Compared to the biofilm-negative group, the biofilm-positive group exhibited lower rates of adequate bowel preparation and lower BBPS scores. No significant differences were observed in the other indicators. Conclusion: The OSS group surpassed the PEG group in bowel preparation, but adding 290 µg of linaclotide did not boost its quality. Notably, intestinal biofilm negatively impacted bowel preparation quality.