A long time ago (more than 3 decades by now), we worked on a crash project to bring a colon lavage preparation (this is a concoction that clears out one’s bowels) to the market. At the time, the risk of death from bowel surgery was unacceptably high. And, the chance of having the patient develop an infection resulting from the surgery was almost certain. The goal of this new product was to cut those situations close to zero.

Colyte (and its sister product, Golytely) did just that. These preparations were isotonic (the same inorganic composition) and iso-osmotic (did not draw fluid into or out of the colon from the rest of the body)- in other words the perfect concoction. And, they performed exactly as desired by the medical practice.

Well, that doesn’t really take the whole situation into perspective. Sure, the docs were happy. Sure, the hospitalists were happy. Sure, our client was happy. But…

Those folks TAKING the preparation….. NOT so much. The prep’s taste was (I’m being diplomatic here) simply vile. And, when we tested various flavoring “improvements”, things got worse. Some of the flavorings made it feel even slimier, or worsened the (already poor) taste.

(NOTE: I was among those testing these improvements. Let me tell you that I may love chocolate and apple, but these added flavorings rendered the prep taste akin to eating rotten apples or centuries-old chocolate.)

Moreover, when you take these preps, you need to be near a commode. OK. You need to be ON the commode. Because, they DO work. Imagine (if you’ve never been subjected to the ordeal) drinking a fluid that operates like Roto-Rooter.

But, because they worked, the preps thrived. And, because they worked, a whole new business opportunity for the medical professionals arose. Colonoscopy. After all, if a patient didn’t need to undergo an enema (which took another medical professional and hours of time)- and had a clean bowel (enemas don’t fully evacuate the bowel to the same pristine state), things were looking pretty good. (Don’t look in the commode!)

But, now, a new approach seems to be coming to the market. OK. Not fully new. This group is developing foods infused with PEG-3350 (polyethylene glycol polymers of molecular weight 3350) that it feels will do the trick. They think the PEG-3350 is the magic bullet in Colyte. Except, (here comes the plug) the prep is an adjuvancy- a group of materials that work together to make the whole thing work better.

Why develop new drugs?  After all, about ½ the folks who are prescribed colonoscopic exams skip them. (These are folks who are being ‘scoped’ for general reasons, as part of prevention of major issues.) And, a good portion (40% or so) of the folks who skip the exam do so because they are not willing to take some 2 to 4 liters of Colyte or Golytely- but many others simply are not willing to have the scope traverse their anus and colon.

Colonary Concepts, Inc. is producing these meals infused with PEG-3350, along with sorbitol (a sweetener) and ascorbic acid (Vitamin C). The subjects (all were scheduled for routine screening colonoscopies, except for 3 who were having follow-up procedures because they were previously found to have adenoma) were provided with menus for their food choices during the test.

The 3 ingredients had been blended into the foods (which included pasta, pretzels, smoothies, and a children’s version of pina colada (i.e., non-alcoholic)- and the menus were chosen to ensure electrolyte stability. 8 subjects consumed the desired menu, while the other 2 attained 95% (hmm- I wonder how that number was computed) of the target. The researchers didn’t use the entire census of 30 subjects that were lined up for the protocol since they were pleased with the initial results.

The results, according to endoscopists’ evaluations were considered to be good (9 folks), with one discerned as excellent. (When using Colyte properly, all the evaluations for bowel cleansings are rated as excellent.) There were only 10 patients involved in this study.  Note also that the results for the ascending colon portion were dramatically lower- 3 were considered to fair and the rest (7) good.

Colonary Concepts is now involved in phase II trials. The phase II trials are being held at two centers, with a total of 160 subjects. And, the “foods” will be a little different. Shakes (vanilla, strawberry-banana flavoring) and food bars (white chocolate, lemon, coconut) are expected to fill the bill (or is that the colon?).

(As an aside, we tried making a “smoothie” version of Colyte. OK. We made it fine. It, too, tasted simply vile. We also tried almost freezing the concoction, making a slushy of sorts. That was slightly better. But, it took lots of work, and that work was going to have to be done by the patient. So, we junked the concept.)

The developers behind Colonary Concepts are Drs. Corey Siegel and Joshua Koreznik (and Doug Knuth). Siegel and Knuth are from Dartmouth; Koreznik is affiliated with Harvard.

Bottoms up?

An update:  Will Smith provides a you tube video of his colonoscopy “experience”.   No, you won’t see the results of his prep- he’ll just describe that it took a few hours for “just water”…