Effect of linaclotide combined with polyethylene glycol on bowel preparation before colonoscopy in patients with constipation

Background: Linaclotide, a promising medication for treating irritable bowel syndrome with predominant constipation, has the potential to enhance bowel preparation for colonoscopy. This study aims to evaluate the efficacy and tolerability of linaclotide combined with low-volume polyethylene glycol (PEG) in constipated patients. Methods: In this randomized, single-blind controlled trial, 210 constipated patients were assigned to one of three groups: (1) 3 L PEG (standard regimen), (2) 2-day linaclotide + 2 L PEG (2D + 2 L PEG), or (3) 4-day linaclotide + 2 L PEG (4D + 2 L PEG). Bowel cleansing was assessed using the Boston Bowel Preparation Scale (BBPS). Adverse symptoms, detection rates of intestinal findings, patient satisfaction, and willingness to repeat the procedure were recorded. Results: No significant differences in overall BBPS scores or detection rates were observed among the three groups. However, the 4D + 2 L PEG group showed superior left colon cleansing compared to the 2D + 2 L PEG group. Both linaclotide groups experienced fewer adverse symptoms (bloating, nausea, and vomiting) and reported higher satisfaction than the 3 L PEG group. Conclusion: A four-day regimen of oral linaclotide combined with 2 L PEG offers effective and well-tolerated bowel preparation with fewer adverse symptoms, making it a favorable option for constipated patients undergoing colonoscopy. Clinical Trial registration: http://www.chictr.org.cn (registration no. ChiCTR2400083515).