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4114512 
Journal Article 
Abstract 
Aphthous ulceration in the colon after sodium phosphate bowel preparation for colonoscopy 
Atkinson, RJ; Hunter, JO 
2002 
Yes 
Gut
ISSN: 0017-5749
EISSN: 1468-3288 
50 
A72-A72 
English 
WOS:000174481500265 
Introduction: It appears to be little known that sodium phosphate, a laxative used in bowel preparation for colonoscopy, may potentially damage the colonic mucosa. A 51 year old man undergoing colonoscopy for chronic diarrhoea was found to have severe aphthous ulceration of the sigmoid and histology suggested Crohn’s disease. No treatment was prescribed, but three weeks later a second examination, after a phosphate enema rather than sodium phosphate, was both endoscopically and histologically normal. We suspected that the ulcers were caused by the bowel preparation and we therefore reviewed the presence of aphthous ulceration, in a series of reports of colonoscopies where either sodium phosphate (Fleet) or sodium picosulphate (Picolax) had been used for bowel preparation.

Methods: 175 consecutive colonoscopy reports were retrospectively reviewed with respect to age, sex, indication for the exam and the presence of ulceration.

Results: Sodium picosulphate was used in 124 colonoscopies and sodium phosphate in 51. The groups were evenly matched for age and sex. Aphthous ulceration was documented in 4/124 (3.2%) after sodium picosulphate but 7/51 (13.7%) after sodium phosphate {p=0.015; Fisher’s Exact Test}. The incidence of ulceration in patients known to have inflammatory bowel disease was only 3/27 and the incidence of ulcers was only significantly increased in the group whose indication for the exam was altered bowel habit. (1/24 [4.2%]; 6/23 [26.1%] {p=0.048; Chi squared test}.

Conclusion: It has been shown previously that sodium picosulphate can cause colonic ulceration. Our series confirms this finding which might potentially lead to an incorrect diagnosis and unnecessary treatment. The use of sodium phosphate preparation in patients suspected of having inflammatory bowel disease may be inadvisable.