Patients with inflammatory bowel disease (IBD) require colonoscopy for diagnosis, disease activity assessment, and dysplasia surveillance. Patients with IBD reported lower satisfaction with sedation during colonoscopy and increased procedural pain compared with individuals without IBD. This study aimed to examine sedation requirements of IBD patients undergoing colonoscopy. 

A retrospective cohort study of IBD and non-IBD patients presenting for colonoscopy between January 2020 and December 2024 was undertaken. Data collected included patient and procedure focused variables. Sedation was performed as intravenous conscious sedation (IVCS) using midazolam and propofol. The opioid analgesic, pethidine was added If the sedation level was not adequate for procedures.  

A total of 1655 consecutive colonoscopies (253 IBD, 1402 non-IBD) were analyzed. For IVCS, 11.1% of IBD patients required Midazolam only(M), 41.9%, Midazolam and propofol (MP), and 47.0%, Midazolam, Propofol and opioid (MPO) versus 11.7% of non-IBD required M, 69.1% MP and 19.2% MPO respectively. Among IBD patients (CD 52, UC 201), active disease state required MPO in 51,6% (66/128) versus inactive state 42,4% (53/125) (p=0.18). Propofol administration (mg) was 25.4±13.3 in IBD and 23.7±12.7 in non-IBD (p=0.07).

IBD patients required more opioid analgesic for IVCS compared with non-IBD patients. IBD patients showed similar opioid requirement both active and inactive disease state.  Since patients with inflammatory bowel disease consistently show a low pain threshold even in a remission state, these study results show that it is necessary to administer appropriate analgesics together to increase patient satisfaction during IVCS.