Senna Group Research Articles

Bowel preparation with linaclotide and 1 L polyethylene glycol plus ascorbic acid prior to colonoscopy in chronic constipated patients

Background and Aims Information on effective bowel preparation (BP) methods for patients with constipation is limited. We recently reported the efficacy of 1 L polyethylene glycol plus ascorbic acid (PEG-Asc) combined with senna for BP; however, this regimen was insufficient in patients with constipation. We hypothesized that the addition of linaclotide, which is approved for the treatment of chronic constipation, to 1 L PEG-Asc would yield results superior to those of senna in patients with constipation. Methods This was a retrospective, single-center study that included outpatients with constipation who underwent BP prior to colonoscopy between March and December 2019 (receiving 1 L PEG-Asc with 24 mg senna) and between January and October 2020 (receiving 1 L PEG-Asc with 500 mg linaclotide). Results A total of 543 patients with constipation were included, of whom 269 received linaclotide and 274 received senna. The rate of inadequate BP was significantly lower (11% vs 20%, p < 0.01) and the adenoma detection rate was significantly higher (54% vs 45%, p = 0.04) in the linaclotide group than in the senna group. Multivariate analysis revealed that the linaclotide regimen significantly reduced the risk of inadequate BP (odds ratio = 0.36, 95% confidence interval = 0.21–0.60, p < 0.01). Conclusions The linaclotide regimen significantly increased BP efficacy and the adenoma detection rate compared with the senna regimen without reducing tolerability and is therefore a promising new option for BP in patients with constipation.

Effectiveness of senna in treating chronic constipation in geriatric patients presenting to the emergency department: A randomized, double-blind, multicenter study

Introduction: Chronic constipation is prevalent in the geriatric population. Undiagnosed and untreated constipation can lead to complications and decreased health-related quality of life. The aim of this study was to compare the therapeutic effectiveness of senna alone with a combination of bisacodyl and senna in patients diagnosed with chronic constipation. Materials and Method: This prospective, multicenter, double-blind, randomized controlled trial included patients aged 65 years and older who presented to the emergency department with chronic constipation, diagnosed according to the Rome IV criteria, between July and October 2023. Patients were randomly assigned to either the senna group (20 mg sennoside B) or the senna + bisacodyl group (3 mg sennoside B + 5 mg bisacodyl). Participants took the drugs twice daily for 28 days. The Constipation Scoring System and Patient Assessment of Constipation Quality of Life scores were calculated before and after treatment for each patient. Results: The study included 105 patients, with 54 in the senna group and 51 in the senna + bisacodyl group. There was a statistically higher need for dose reduction because of drug side effects in the senna + bisacodyl group compared with the senna group (p=0.026). Following treatment, the senna group had a higher score on the Constipation Scoring System and Patient Assessment of Constipation Quality of Life compared with the senna + bisacodyl group, and the difference was statistically significant (p&lt;0.001, p=0.012). Conclusion: In geriatric patients, short-term treatment of chronic constipation with senna is more effective than senna+bisacodyl regarding constipation severity and quality of life. Keywords: Aged; Bisacodyl; Constipation; Quality of Life; Sennosides.

Low volume polyethylene glycol combined with senna versushigh volume polyethylene glycol, which regimen is better for bowel preparation for colonoscopy? A randomized, controlled, and single-blinded trial.

Background and AimsBowel preparation affects the quality of colonoscopy. Reaching the optimal preparation has been a challenge for years. Polyethylene glycol (PEG) is the sole FDA‐approved substance for this purpose. However, patients find it unpleasant and often complain about its adverse effects. In this study, we aimed to reduce these complaints by lowering the amount of PEG and adding senna which is an herbal stimulant laxative.MethodsFour hundred and eighty‐six patients were admitted for colonoscopy. Finally, 382 patients were enrolled in the study and we divided them into two groups; 186 patients were placed in which conventional high volume PEG‐alone regimen was consumed and 196 patients in which low volume PEG plus senna regimen was offered. The quality of colon preparation was compared between the two groups by independent two samples t‐test (or its corresponding nonparametric test), Fisher's exact, or χ 2 test in SPSS software version 22.ResultsThe colon preparation quality was equally efficient in the two groups as 69.36% in the high volume PEG group and 71.94% in PEG plus senna group had adequate bowel preparation (p = 0.58). Adverse effects, like nausea, bloating, headache, and sleeplessness were significantly less in the low volume PEG plus senna group.ConclusionBesides the fact that bowel preparation by low volume PEG plus senna combination was noninferior to the conventional high volume PEG‐alone regimen, the side effects were much less common with the low volume PEG plus senna regimen.

Bowel Preparation for Colonoscopy in Children: 1 Day PEG-3350 with Bisacodyl versus 3 Day Sennosides

Background and Objectives: Bowel preparation (BP) for colonoscopy is a challenging procedure in children and different regimens have been used for this purpose. Polyethylene glycol (PEG) is the most preferred agent in recent years. The primary aim of this study was to evaluate the efficacy of 1-day PEG-3350 with bisacodyl (PEG-B) and comparing it with 3-day sennosides A+B. Method: In this prospective, randomized, and single-blinded study, children aged 2–18 years were included in the PEG-B group for 1 day or in Senna group for 3 days. The effectiveness of BP was assessed according to the Ottawa and Boston BP scales, compliance and adverse effects were also recorded. Pre- and post-preparation biochemistry were obtained for investigation of safety of both regimens. Results: Successful BP was observed in 88.3% (n = 53/60) of PEG-B and 86% (n = 55/64) of Senna groups according to Boston scale, and it was 85% (n = 51/60) and 84.4% (n = 54/64), respectively, according to Ottawa scale. The cecal intubation rate was 96.7% (n = 58/60) in the PEG-B group and 93.8% (n = 60/64) in the Senna group. Ease of administration and disturbance in regular daily activities was better in the PEG-B group (p < 0.05). There was no major adverse event and biochemical abnormality in both groups. The correlation between Ottawa and Boston scales was found to be excellent (r² = –0.954, p < 0.01). Conclusions: The efficacy, safety, and adverse effect profile of 1-day BP with PEG-B regimen was found to be similar to 3-day sennosides regimen, however, the PEG-B regimen had advantages such as short duration, ease of administration, and better patient comfort. Also, high correlation rate between the Boston and Ottawa scales in pediatric patients was remarkable.

Adding stewed apricot juice to sena improves the right-side and overall colon cleansing quality for colonoscopy preparation

Background: To achieve optimal colonoscopic examination, the bowel must be sufficiently cleansed. However, none of the currently available colonoscopy preparation regimens is safe, efficient and comfortable. The aim of this study was to determine whether adding stewed apricot juice to senna increased patient comfort and improved bowel cleansing during colonoscopy preparation.Methods: Outpatients of both genders, aged over 18 years, who were referred for elective colonoscopy were randomly allocated to drink stewed apricot juice with senna or senna alone. The quality of colon cleansing was evaluated using the Ottawa scale. The evaluation of patient tolerance and adverse events was made through completion of a questionnaire. Results: The study included a total of 128 patients in the randomization procedure. A significantly greater effect of cleansing was determined with stewed apricot juice plus senna in the right and transverse colon (p= 0.038, p=0.037, respectively). It was also determined that in the stewed apricot juice plus senna group, overall cleansing was superior (p&lt;0.001), total colonoscopy (17.6 min vs 22.8 min, p=0.048) and cecal intubation (7.4 min vs 11.2 min, p=0.042) times were shorter, and the colonoscopy procedure was easier (79.4%vs 49.2%, p&lt;0.001). No difference was determined between the groups in respect of patient acceptance, compliance and adverse events (p&gt;0.05). In the stewed apricot juice plus senna group, 91.2% of patients stated willingness to receive the same regimen in the future compared with 80% of the patients in thesenna alone group (p=0.037).Conclusion: The addition of natural, stewed apricot juice to senna significantly improves cleansing outcomes without additional adverse events.Keywords: bowel cleansing, colonoscopy, stewed apricot juice, senna.

Efficacy of daiokanzoto in chronic constipation refractory to first-line laxatives.

There are only a few treatment options for constipation and limited evidence of suitable treatments. Daiokanzoto (DKT) is a Kampo medicine often used clincally to treat constipation. DKT is a laxative used predominantly in Japan; however, clinical data on its efficacy and safety is lacking. Patients who used DKT, but were intolerant to either magnesium oxide (MgO; MgO group; n=16) or senna extract (Senna group; n=26) were included in the present study. The frequencies of their bowel movements were compared during the 1 week prior to and following DKT administration. Within 24 hours after DKT administration, 93.8% of the patients in the MgO group evacuated their bowels. The median bowel movement frequency 1 week prior to DKT administration was 2.5 and 1 week after DKT administration was significantly increased to 7.5. In the Senna group, within 24 h of DKT administration, 80.8% of the patients evacuated their bowels. The median bowel movement frequency 1 week prior to the DKT treatment was 2.0, which significantly increased to 8.5 1 week after the administration of DKT. The adverse events from DKT treatment were mild and controllable.

Two low-dose bowel-cleansing regimens: efficacy and safety of senna and sodium phosphorus solution for colonoscopy.

BackgroundThe aim of the present study was to compare the efficacy, adequacy, side effects, and patient compliance of sodium phosphorus (NaP) and senna solutions when preparing the colon before colonoscopy.MethodsA total of 137 consecutive patients who were considered for colonoscopy evaluation had randomly received one of two premeditated regimens: 90 mL of oral NaP (NaP group) or 500 mL of 1,000 mg of sennosides A and B calcium +66.6 g of sorbitol (senna group). Patients’ compliance with the bowel-cleansing method was determined using a questionnaire prior to the colonoscopic examination. On the other hand, the adequacy of the bowel-cleansing method was evaluated by the colonoscopist who was blind to the bowel-cleansing regimen used prior to the examination of the colon from the rectum to the cecum.ResultsNausea and vomiting complaints were seen more frequently in the NaP group than in the senna group (47 vs 28 and 31 vs 10; P<0.05 and P<0.01, respectively). The response to the question of whether the patients would like to use the same regimen again or not was similar in both groups. The acceptable bowel-cleansing rate was also comparable across both groups. Nevertheless, the number of patients that experienced excellent bowel cleansing in terms of general appraisal of the colonoscopic evaluation was significantly greater in the NaP group than in the senna group (46 vs 25; P<0.001).ConclusionAlthough bowel cleansing was better in the NaP group, both cleansing regimens were comparable regarding the admissibility of the preparations for the procedure. The senna regimen is, however, superior to the NaP regimen in terms of application compliance and its side effects, and it may be an effective alternative for cleansing the bowel prior to colonoscopic examination.

Three kinds of laxatives in the comparative study of the effect of bowel preparation

Objective The new method of re-evaluation of drugs in bowel preparation , to explore an effective bowel preparation medication and measures to improve the success rate of colonoscopy and treatment . Methods Between January 2011 and December 2012 , 85 simple colon polyps patients were recruited . According to the principles of self-control design , cases were received 3 times of colonoscopy , and they were divided into 3 groups according to the bowel preparation medication： group A （ 20% Oral Mannitol group ） , group B （ oral 50%magnesium sulfate group ） , group C （ orally taken Senna group ） .3 groups of patients after intestinal cleanliness were investigated with Boston bowel preparation scale .Results PPBS scores after left colon, transverse colon, right colonand the entire colon intestinal cleansing effects of the three groups , while the differences were no statistically different （ H =1.103, 1.377, 0.179, 0.160, respectively;P ＆gt;0.05 ）. Conclusions Oral administration of 20%mannitol,50%magnesium sulfate, and senna bowel cleansing has no significantly difference in bowel cleansing . Care and health education are important factors for intestinal cleansing of bowel preparation . Key words: Colonoscopy bowel preparation; Mannitol; Magnesium sulphate; Senna

Lubiprostone vs Senna in postoperative orthopedic surgery patients with opioid-induced constipation: a double-blind, active-comparator trial.

To investigate the efficacy of lubiprostone compared to Senna on bowel symptoms and constipation in post-operative orthopedic patients treated with opioids. In this double blind, randomized, active comparator trial, adults who required opioids for analgesia following orthopedic procedures and who were admitted in inpatient rehabilitation were randomized following baseline assessments to lubiprostone (Amitza(®)), orally twice a day or Senna (generic) two capsules administered daily for six days. Subjects were assessed using the patient assessment of constipation (PAC)-symptoms (PAC-SYM) and the PAC-quality of life (PAC-QOL) scales measured at baseline and Day 7; Subjects were assessed daily for secondary measures included the Bristol stool scale bowel consistency, specific bowel symptom score (Nausea, cramping, straining, completeness, abdominal pain, time per lavatory attempt, assistance needed), adverse events and rescue medications required. Function was measured using the functional independence measure (FIM) at admission and discharge; length of stay (LOS) and missed treatments due to gastrointestinal symptoms were also assessed. 64 adults were enrolled; 56 participants (28 in each group) had baseline and follow up measures and were included in the intention to treat (ITT) analyses. 43 participants completed the study, 21 in the active lubiprostone and 22 in the active Senna group. The mean age of the participants was 71.5 years (SD = 11.4 years, range: 28-96 years). In the ITT analyses, participants showed significant improvement in bowel symptoms as measured by the PAC-SYM (mean ± SD, -0.28 ± 0.60, range: -1-2.33) and PAC-QOL (mean ± SD, 0.33 ± 0.81, range: -1.5-2.0) over time, but there were no significant differences between the lubiprostone and Senna groups in mean change in the PAC-SYM (-0.20 ± 0.60 vs -0.36 ± 0.61, P = 0.61 respectively) or the PAC-QOL (0.29 ± 0.76 vs 0.37 ± 0.87, P = 0.61 respectively). The mean change in each bowel symptom also did not significantly differ between treatment groups on ITT analyses, except for completeness of bowel movement, with the Senna group showing greater negative mean change in bowel movement completeness (-0.56 ± 1.01 vs -2.00 ± 1.41, P = 0.03) and for reduction of abdominal pain, favoring Senna (-0.14 ± 0.73 vs -0.73 ± 1.08, P = 0.04). Fifteen (75%) participants in the lubiprostone and in the Senna group requested rescue treatments. Participants made significant functional improvement from admission to discharge over a median LOS of 12 d, with a mean FIM change of 29.13 ± 13.58 and no significant between group differences (27.0 ± 9.2 vs 31.5 ± 16.6, P = 0.27). Both lubiprostone and Senna improved constipation-related symptoms and QOL in opioid-induced constipation, with no significant between-group differences.

Bowel Preparation in Children

of dose and duration of PEG preparations that will be useful for C olonoscopy is an important diagnostic and therapeutic procedure to evaluate the colon and terminal ileum in children. Anadequatebowelpreparationisnecessaryforcompletevisualization ofboththecolonandterminal ileum.Inadequatebowelpreparationcan lead topoorcolonicvisualization,missed lesions, increasedprocedure time, and possibly a repeat procedure. From the patient’s perspective, taking a complete bowel preparation is often the most difficult part of the procedure. Over the years, there have been many bowel preparations used in children (1). Medications that have been used include polyethylene glycol electrolyte lavage solution, magnesium citrate, sodiumphosphate, senna,bisacodyl, phosphateenemas,and, recently, polyethylene glycol without electrolytes (PEG). The protocols also vary regarding the length of preparation, length of duration of clear liquid diet, and doses of medications. There have been extremely few head-to-head comparison studies of different bowel preparations in children. In this issue of theJournalofPediatricGastroenterologyandNutrition,Terryetal (2) evaluated the efficacy of PEG versus senna for bowel preparation in children.The study was a well-designedblinded,prospective randomized trial. The authors aimed to recruit 166 children. Patients were randomlyassignedtoreceivePEG1.5g kg 1 day orsenna(15–30 mL/day) for 2 days before the colonoscopy. The interim analysis of 30 patients showed clear superiority of PEG preparation compared with senna, and the study was terminated. Good/excellent scores of colon cleanliness were seen in 88% of patients in the PEG group compared with 29% in the senna group. Both regimens were generally well tolerated without any significant clinical adverse effects or electrolyte changes. Despite the small sample size, the results of the PEG preparations were impressive compared with senna. PEG has revolutionized the treatment of constipation in children. It has been shown to be an effective and safe therapy long term (3). It is palatable, as it can be mixed in any beverage, and therefore the compliance with PEG therapy is excellent. Because of these properties, PEG is a good ‘‘candidate’’ for a bowel preparation regimen. In the first reported prospective study, our group gave PEG at a dose 1.5 g kg 1 day 1 for 4 days and documented

Lubiprostone Compared to Senna in the Treatment of Postoperative Opioid-Induced Constipation Following Orthopedic Procedures

Purpose: To assess the efficacy of lubiprostone compared to senna on bowel symptoms and bowel-related quality of life in patients undergoing inpatient rehabilitation following orthopedic procedures and who have opioid-induced constipation symptoms. Methods: In this double blind, randomized, active comparator trial, adults admitted to acute rehabilitation following orthopedic procedures exhibiting constipation symptoms and who required opioids for analgesia underwent baseline assessments which included the Patient Assessment of Constipation Symptoms (PAC-SYM) and the Patient Assessment of Constipation - Quality of Life (PAC-QOL) measured at baseline and study exit (Day 7); Secondary Measures included the Bristol Stool Scale Bowel Consistency. Specific Bowel Symptom Score (Nausea, cramping, straining, completeness, abdominal pain, time per lavatory attempt, assistance needed). Participants were randomized to one of two active treatment groups. lubiprostone (Amitza®), 24 μg orally twice a day or senna (generic) two capsules daily administered daily for six days and corresponding placebo tablets. Subjects were followed daily for symptom control, and questionnaires completed at Day seven. Results: Sixty-four adults were enrolled; 58 participants (28 in each group) completed baseline and Day seven assessments and were included in intention to treat (ITT) analyses. Forty-three participants completed the study, 21 in the active lubiprostone and 22 in the active senna group. The mean age of the participants was 71.5 (SD=11.4, range 28-96) years. In the ITT analyses, study participants showed significant improvement in bowel symptoms as measured by the PAC-SYM (mean change ± SD = -0.28±0.60, range -1 to 2.33) and PAC-QOL (mean change ± SD=0.33 ±0.81, range -1.5-2.0) over time, but there were no significant differences between the lubiprostone and senna groups for change in the PAC-SYM (mean change ± SD= -0.20±0.60 and mean change ± SD = -0.36±0.60, respectively) or the PAC-QOL (mean change ± SD=0.29 ±0.76 and mean change ± SD=0.37±0.87, respectively). The mean change in each bowel symptom also did not significantly differ between treatment groups for ITT analyses, nor did PAC-SYM subscales. Fifteen (75%) participants in the lubiprostone and 18 (78.2%) in the senna group requested rescue treatments (P value=1.00). Conclusion: Participants receiving either lubiprostone and senna demonstrated improved constipation-related symptoms and quality of life over the treatment period in the setting of opioid-induced constipation, however there were no significant differences noted between the two treatment groups in the outcomes measured. Despite daily scheduled use of these two laxative interventions, additional laxatives were frequently required for symptom control. Disclosure: Dr. Marciniak's Spouse - consultant Takeda. This research was supported by an industry grant from Takeda Pharmaceuticals.

Half Doses of PEG-ES and Senna vs. High-Dose Senna for Bowel Cleansing Before Colonoscopy: A Randomized, Investigator-Blinded Trial

Patients' compliance with and tolerance of large-volume polyethylene glycol electrolyte solution (PEG-ES) have prompted continuous investigation with alternative forms of cleansing. High-dose senna is superior to PEG-ES for the quality of bowel cleansing, patient compliance, and tolerance, but its acceptance may be influenced by the incidence of abdominal pain. We hypothesized that a combination of half doses of PEG-ES and senna could minimize the incidence of abdominal pain without affecting the quality of bowel preparation. This randomized, investigator-blinded trial has been conducted on consecutive outpatients scheduled for elective colonoscopy at a single community-based hospital. Patients were randomly assigned to receive either 12 tablets of 12 mg senna and 2 l of PEG-ES (half-dose group, HDG) or 24 tablets of senna divided in two doses (senna group, SG) the day before colonoscopy. The main outcome measures were the quality of colon cleansing (Aronchick scoring scale) and the incidence of preparation-related abdominal pain. Secondary outcome measures were patients' compliance with the cleansing regimen, overall tolerability, prevalence of predefined side effects, and quality of right colon cleansing. A total of 296 patients were enrolled (HDG=151 and SG=145). Overall cleansing was excellent to good in 90.1 and 88.3% patients in HDG and SG, respectively (P=0.62). Preparation-related moderate-to-severe abdominal pain was reported by 6% patients in HDG and 15.2% in SG (P=0.009). No significant differences were observed for secondary outcomes. The regimen combining half doses of PEG-ES and senna provides high-quality bowel preparation and acceptable patient tolerance, with less abdominal pain compared with high-dose senna.

Bowel Prep for Colonoscopy

Purpose: To compare the efficacy and patient tolerance of an oral high dose of Senna suspension to a conventional sodium phosphate lavage in adults undergoing elective colonoscopy. Methods: Outpatients referred for elective colonoscopy were prospectively and randomly assigned to receive, the day before the procedure, either two doses of liquid Senna each comprised of 90ml (158.4mg equivalent) given at 1 pm and 9 pm (Senna group n = 50), or a standard Sodium Phosphate bowel prep (45 ml of NaP solution) two doses taken the day before the exam (NaP group n = 50). The primary outcome measure was the overall quality of colon cleansing utilizing the Aroncheck scoring scale (1 = excellent to 4 = poor/inadequate). Three investigators/endoscopists participated in the three month trial and all three were blinded to the type of prep assignment. Patient tolerance/compliance was assessed using a structural questionnaire: poor, fair, or good (Symptoms of intolerance, compliance).The data was analyzed using the Mann-Whitney U Test to compare the results of bowel cleansing and Patient tolerance/compliance. Results:Table: Tolerance.Table: Preparation Quality.Tolerance of the Senna preparation and compliance with it were significantly better than conventional Sodium Phosphate.Overall cleansing quality appears to be comparable or slightly better. Conclusions: Given the problems associated with currently available Colon cleansing regimens (Large volume and unpleasant taste of PEG-ES, recent safety concerns with Sodium Phosphate) an oral high dose of Senna is a valid, safe and well tolerated alternative for outpatient colonoscopy preparation. Larger prospective studies are needed.

Comparative study of two bowel preparaton regimens for colonoscopy: Senna tabletsvssodium phosphate solution

To compare the efficacy and acceptance of senna tablet and sodium phosphate solution for bowel preparation before colonoscopy. One hundred and thirty four patients, who needed elective colonoscopy, were randomly allocated to take 180 mg senna tablet or 95 mL sodium phosphate solution on the day before colonoscopy. The efficacies of both laxatives were compared using the mean difference of colon-cleanliness score of the rectum, sigmoid segments, descending colon, transverse colon and cecum. The scores were rated by two observers who were blinded to the laxatives administered. The higher score means that the colon is cleaner. The efficacy of both laxatives were equivalent if the 95% confidence interval of the mean difference of the score of colon lie within -1 to +1. On intention-to-treat analysis, the mean cleanliness scores in the four segments of colon except the cecum were higher in the sodium phosphate group than those in senna group (7.9 +/- 1.7 vs 8.3 +/- 1.5, 8.0 +/- 1.8 vs 8.5 +/- 1.4, 7.9 +/- 2.0 vs 8.5 +/- 1.3, 7.9 +/- 2.0 vs 8.2 +/- 1.4 and 7.2 +/- 1.7 vs 6.9 +/- 1.4, respectively). The 95% confidence intervals (95% CI) of mean difference in each segment of colon were not found to lie within 1 point which indicated that their efficacies were not equivalent. The taste of senna was better than sodium phosphate solution. Also, senna had fewer side effects. The efficacy of senna is not equivalent to sodium phosphate solution in bowel preparation for colonoscopy, but senna may be considered an alternative laxative.

High-Dose Senna Compared with Conventional PEG-ES Lavage as Bowel Preparation for Elective Colonoscopy: A Prospective, Randomized, Investigator-Blinded Trial

To compare the efficacy and patient acceptance of an oral high dose of senna to conventional polyethylene glycol-electrolyte lavage solution (PEG-ES) in adults undergoing elective colonoscopy. Consecutive outpatients referred for elective colonoscopy were prospectively randomly assigned to receive, the day before the procedure, either 24 tablets of 12 mg senna, divided into two doses at 1 p.m. and 9 p.m. (senna group, n=191), or standard 4-L PEG-ES (PEG-ES group, n=92). The overall quality of colon cleansing (primary outcome measure) and cleansing in the right colon were evaluated using the Aronchick scoring scale (1=excellent to 4=inadequate) by the investigator/endoscopist who was blinded to the treatment assignment. Patient acceptance and the safety of the preparation were assessed by a nurse, using a structured questionnaire covering compliance with the dosing, overall tolerance of the preparation (1=none or mild discomfort to 4=severely distressing), and adverse events. The quality of colon cleansing, overall tolerance of the preparation, and compliance were significantly better with senna; overall cleansing was excellent or good in 90.6% of patients in the senna group and in 79.7% in the PEG-ES group (p= 0.003). The percentage of procedures rescheduled because of insufficient colon cleansing was 7.3% in the PEG-ES group and 2.6% in the senna group (p=0.035). Multivariate logistic regression modeling showed the PEG-ES preparation as negative independent predictor of unsuccessful bowel cleansing. The incidence of adverse reactions was similar in the two groups; patients who received senna experienced significantly less nausea and vomiting, but more abdominal pain. An oral high dose of senna is a valid alternative to standard PEG-ES for outpatient colonoscopy preparation.