Jeanne M. Courval

Controlled study of cisapride-assisted lavage preparatory to colonoscopy

BACKGROUND Traditional bowel preparation before colonoscopy involves lavage with approximately 4 L of polyethylene-glycol (PEG)-electrolyte solution. Using prokinetic agents in addition to PEG-electrolyte lavage may decrease the volume required and ease patient preparation. METHODS We conducted a blinded, placebo-controlled trial with the prokinetic agent, cisapride, in addition to standard PEG-electrolyte lavage. Patients were prospectively assigned to receive 20 mg of cisapride (n = 52) or placebo (n = 49) 30 minutes before drinking PEG-electrolyte solution. The volume consumed, time to clean bowel, side effects, and acceptance were recorded. Adequacy of colon cleaning was scored by a gastroenterologist blinded to group assignment. RESULTS Thirty-seven percent of patients assigned to cisapride required more than 3500 mL of PEG-electrolyte, compared with 75% of patients receiving placebo (p < 0.001). Median time to clean bowel was 95 minutes for the cisapride group and 120 minutes for those receiving placebo (p = 0.23). Side effects, patient acceptance, and quality of bowel preparation were not significantly different. CONCLUSION We conclude that administration of 20 mg of cisapride reduces the required volume of PEG-electrolyte solution for bowel preparation. There were also favorable trends in the time required to achieve clean bowel, patient tolerance, and occurrence of side effects.

Fish Consumption and Other Characteristics of Reproductive-Aged Michigan Anglers—a Potential Population for Studying the Effects of Consumption of Great Lakes Fish On Reproductive Health

There has been considerable interest in the benefits and risks of eating Great Lakes fish, particularly with regard to reproductive health. We report the results of a survey conducted from 1993-1995 among Michigan anglers. The survey was designed to identify a reproductive-aged cohort of persons who consume high or low levels of Great Lakes fish in order to study the impact of polyhalogenated biphenyl (PHB) compounds and other toxins on human reproduction outcomes. Using fishing license data obtained from the Michigan Department of Natural Resources, we identified anglers of early reproductive age (18-34 years) in ten Michigan counties. The screening survey ascertained demographic, behavioral, fish consumption, and reproductive history information on anglers and their partners. Over 4,000 angler households were contacted. One thousand nine hundred fifty questionnaires were returned from 1,168 households. The median age of respondents was 30 years; 58% were male and 64% reported being married. Slightly more than one-half the respondents had attended or graduated from college, and less than 10% had not completed high school. In the past year, most respondents (46%) reported having eaten sport-caught fish 1-12 times, while 20% reported having eaten no sport-caught fish; 20% had consumed 13-24 meals. More sport-caught fish was consumed in the spring and summer than in the fall and winter, and males reported eating more fish than females. About 43% of our respondents reported that they intend to have one or more children in the next five years. Of these respondents, 287 couples had no identified impairments to reproduction and therefore would be eligible to participate in the future reproductive study.