A comparative trial of magnesium citrate (Citramag) and Picolax for barium enema bowel preparation

doi:10.1016/S0009-9260(05)81821-5

Clinical Radiology

Volume 49, Issue 6, June 1994, Pages 379-381

https://doi.org/10.1016/S0009-9260(05)81821-5 Get rights and content

It has previously been suggested that a single dose of magnesium citrate produces adequate cleansing of the bowel for barium enema examination. To determine whether such a regimen has any advantage over the widely used two doses of Picolax, a prospective randomized blinded trial was performed with over 100 patients allocated to each of the bowel preparation regimens. Radiographs were assessed for quality of mucosal coating, faecal residue and overall quality of bowel preparation. Patient compliance was good with both regimens. Normal daily activities were inconvenienced significantly more by the Picolax (P<0.001), whereas the magnesium citrate (Citramag) caused more interruption of sleep (P<0.01). Mucosal coating was similar with both regimens. There was more faecal residue and poorer overall bowel preparation with Citramag (P<0.001), although diagnostic accuracy was only infrequently felt to be compromised as a result. Citramag may offer an alternative to Picolax in patients where minimal disruption to daily activities is desirable and where the detection of polyps is not critical.

References (4)

HughesK et al.
A new oral bowel evacuant (Picolax) for colon cleansing
Clinical Radiology
(1983)
LeeJR
Combinations of laxatives for bowel preparation: are they necessary?
Clinical Radiology
(1984)

There are more references available in the full text version of this article.

Cited by (16)

Optimizing bowel preparation for multidetector row CT colonography: Effect of Citramag and Picolax
2003, Clinical Radiology
AIM: To compare the adequacy and acceptability of Picolax and Citramag bowel cleansing agents for CT colonography.
MATERIALS AND METHODS: Multidetector row CT colonography was performed in 124 subjects; 43 had been prepared with Picolax and 81 with Citramag. Datasets were assessed for retained fluid and solid residue, and overall adequacy of segmental visualization. Preparation acceptability was also assessed.
RESULTS: There was significantly less retained fluid with Picolax. The odds of being in the next higher category for retained fluid when using Picolax were 0.33 (CI: 0.22–0.50, p<0.0001) when compared with Citramag, for all segments combined. However there was significantly more retained solid residue with Picolax. The odds of being in the next higher category for retained residue when using Picolax were 2.44 (CI: 1.41–4.24, p=0.002) when compared with Citramag, for all segments combined. There was no significant difference with respect to overall segmental visualization: the odds of a segment being adequately visualized when using Picolax were 1.52 (CI: 0.88–2.65, p=0.14) when compared with Citramag. There was no significant difference with respect to acceptability.
CONCLUSION: Picolax results in a significantly drier colon than Citramag and associated with more retained residue. We found Picolax the more suitable preparation for CT colonography.
A new magnesium-containing PEG-electrolyte solution for the oral lavage of the colon
1999, Clinical Radiology
AIM: The aim of the present study was to verify whether the addition of magnesium ions to an electrolyte solution containing polyethylene glycol (PEG-ELS) for the oral lavage of the colon increases barium mucosal coating at the time of double-contrast barium enema (DCBE) examination.
MATERIALS AND METHODS: The two patients from 60 pairs of patients undergoing DCBE with a standardized technique were randomly subjected to bowel preparation with sennosides and an isotonic PEG-ELS (SELG®, Promefarm, Italy), or sennosides and a modified isotonic SELG preparation to which 7.5 g/1 of magnesium sulphate were added. Mucosal coating, residual fluid and colon cleansing were assessed independently by three radiologists. The null hypothesis was tested by means of Wilcoxon's signed-rank test.
RESULTS: Barium mucosal coating was judged to be significantly better in the SELG-Mg members (P<0.0001). The amount of residual fluid was significantly lower in SELG-Mg members (P<0.0001). There was no difference in colon cleansing (P = 0.690). These results demonstrate, in a simple way, that magnesium ions increase barium coating of the colon mucosa in vivo. The underlying mechanism seems to be the increase in viscosity of barium suspension by free water subtraction owing to the hydrophilia of magnesium ions.
CONCLUSION: The integration of magnesium in a newly designed isotonic PEG-ELS could be the correcting factor for the poor barium mucosal coating that normal solutions for the oral colon lavage induce.
A comparison of fleet phospho-soda with picolax in the preparation of the colon for double contrast barium enema
1998, Clinical Radiology
This study was performed to compare the patient acceptability and the efficacy of two different agents for bowel preparation prior to double contrast barium enema. Onehundred and ninety-four outpatients were randomized to have either two sachets of Picolax or two bottles of Fleet Phospho-soda and restricted to clear fluids on the day prior to their examination. Patients answered a short questionnaire before their enema. The decubitus films were assessed for faecal residue and bowel coating by three observers blinded to the type of preparation used. There was no significant difference in faecal residue nor in the bowel coating between the preparations. However patients found Picolax significantly easier to take, being better tasting and provoking less nausea and vomiting than Fleet Phospho-soda.
Ischemic colitis caused by oral hyperosmotic saline laxatives
1997, Gastrointestinal Endoscopy
A blinded clinical trial comparing conventional cleansing enema, Pico-salax and Golytely for barium enema bowel preparation
1996, Brain and Language
An evaluator-blinded randomized clinical trial was undertaken to assess the effectiveness and patient acceptance of three bowel cleansing regimens: conventional cleansing enema, Pico-salax and Golytely.
One hundred and fifty patients, referred for barium enema examination, were allocated to one of the three regimens. Both the radiographers and the radiologists did not know the method of preparation. Radiographers were requested to enter the patients' data, the number of bowel openings, the patients' comments of the preparation and side effects. Films were reviewed independently by two experienced radiologists for the degree of bowel cleanliness and quality of barium coating.
The mean (standard deviation) of bowel opening frequency for the cleansing enema, Pico-Salax and Golytely were 3.6(4.4), 8.3(4.8) and 7.1(4.2), respectively, with less bowel opening in the cleansing enema. There was less nausea associated with the cleansing enema (P = 0.006), more vomiting with Golytely (P = 0.008), less abdominal fullness with Pico-salax (P = 0.0006), less anorectal irritation with Golytely (P = 0.025), and no difference in abdominal pain amongst three groups. There was no statistically significant difference in the number of bowel openings between the groups. Patients found that Pico-salax tasted better than Golytely (P = 0.0094) and Golytely was less accepted in the amount of fluid intake (P = 0.0018 and P < 0.0002 comparing Golytely with the cleansing enema and Pico-salax). Chi-squared testing showed no statistically significant difference in bowel cleanliness and quality of barium coating among the three preparations.
There was no difference in the effectiveness of the three regimens. Pico-salax seems the most acceptable because it has the fewest side effects.
Bowel preparation for barium enemas
1994, Clinical Radiology

View all citing articles on Scopus

View full text