Product Review

A Better Bowel Prep?

Colonoscopies are important diagnostic and screening procedures; they help physicians diagnose gastrointestinal diseases such as celiac disease, Crohn’s disease, ulcerative colitis, diverticular disease, and colon cancer. Negative results from these scopes also offer a patient peace of mind when a physician can rule out specific diseases. For the procedure to go smoothly, a patient must fully empty his or her large intestine (bowel) in advance by using specialized bowel preparations (prep), which clear out the fecal matter while replenishing electrolytes. A bowel preparation is not the same as what is known as a bowel cleanse, which is not recommended.

Along with drinking the preparation fluid, patients must abstain from solid food and follow a diet of clear liquids. An adequate prep is essential for the colonoscopy, so that the physician can see easily whether there are any polyps, lesions, or disturbances on the walls of the bowel. Failing to prep the bowel could lead to cancelling the procedure, which forfeits a valuable spot in the colonoscopy queue, and compounding healthcare costs.

There are two main types of bowel preps available on the market today:

  1. Pico-Salax® (sodium picosulfate, magnesium oxide, and citric acid), which has been available and safely used worldwide for more than 30 years.
  2. Polyethylene glycol (PEG), including the brands Colyte®, PegLyte®, GoLYTELY®, and Klean-Prep™. A major drawback of this group is the requirement to drink 4L of the solution, which might be too much for some patients.

A new product,Moviprep®, is a pleasant-tasting PEG-based laxative that requires patients to drink only 2L of the preparation fluid (along with 1L of any clear liquid, including specific juices, pop, and broths). You can even choose to take Moviprep® in two doses: one in the evening before the colonoscopy and one on the morning of the procedure. Unlike other PEG bowel preparations, Moviprep® contains a form of vitamin C (ascorbic acid). Your body can only absorb a certain amount of ascorbic acid at a time and the excess remains in the bowel, where it draws in liquid, helping to move fecal matter through more swiftly.

Moviprep® works very quickly, so make sure you have access to a toilet at all times once you start consuming the product. It begins by making bowel movements looser and more frequent but within an hour or so of taking it, the patient will likely experience diarrhea.

GI Society staff tasted Moviprep® and found it to have a light citrus flavour, similar to that of chewable vitamin C tablets, with a hint of saltiness, due to the added electrolytes.

Two recent studies compared the efficacy of Moviprep® to that of other bowel preparations. One study tested whether Moviprep® or Pico-Salax® provides a cleaner colon in individuals who take one of the solutions before a colonoscopy.1 The researchers looked at cleanliness in three sections of the large intestine (cecum, ascending colon, and descending colon) in 65 participants. Although both products offered a similar level of overall cleanness in the bowel, Moviprep® worked much better at cleaning the cecum and ascending colon. Patients preferred the taste of Pico-Salax®, but this difference was minor, and no patients reported the taste of either preparation being difficult to take. The products had similar adverse side effect profiles.

The other study compared the efficiency of a standard PEG solution (Klean-Prep™) and Moviprep®.2 The researchers used the same method of analysis as in the previous study, by observing the cleanliness of the colon, section by section, in 308 participants. They found that the two preparations worked equally well, but more individuals found that Moviprep® had a pleasing flavour, and that the whole dose went down easily.

Overall, Moviprep® may offer better cleaning of certain parts of the large intestine than other types of bowel preparations, allowing for a more efficient colonoscopy. In addition, the palatable taste and the low volume of liquid that patients are required to consume also makes it a more patient-friendly bowel preparation than other PEG laxatives.

First published in the Inside Tract® newsletter issue 179 – 2011
Note: The GI Society has received no remuneration from Moviprep® or its affiliates for this review.
1. Worthington J et al. A randomised controlled trial of a new 2 litre polyethylene glycol solution versus sodium picosulphate + magnesium citrate solution for bowel cleansing prior to colonoscopy. Current Medical Research and Opinions. 2008;24(2):481-8.
2. Ell C et al. Randomized Trial of Low-Volume PEG Solution Versus Standard PEG + Electrolytes for Bowel Cleansing Before Colonoscopy. American Journal of Gastroenterology. 2008;103:883-93.