Various media outlets have sensationalized your article on colon cleansing, “The dangers of colon cleansing” (J Fam Pract. 2011;60:454-457). The article has been perceived by many as a generic criticism of many forms of colon cleansing, with some inappropriate conclusions about widespread harm.
The article included 2 case reports that were incomplete and unclear; no specific diagnosis was made in either case. Authors Mishori et al tried to ascribe negative outcomes to colon cleansing, but the co-mingling of different treatments is apparent in their writing. In other words, colonic hydrotherapy and laxative agents are 2 quite distinct treatments used to facilitate the passage of stool, with different mechanisms of action and potential outcomes, beneficial or otherwise. The authors, in effect, compared apples and oranges, then reached conclusions about colon cleansing that were potentially misleading, generalized, or even naïve.
The first case report described an alleged negative outcome of colon hydrotherapy (colonic irrigation), which may or may not have been directly attributable to the procedure. Furthermore, the procedure was undertaken in an individual with Crohn’s disease, a clear contraindication. To conclude from this case report that colon hydrotherapy is harmful overall has no scientific basis.
The second case report involved the consumption of some form of herbal laxative formula that is not disclosed by the authors. The gastroenterologist who performed a colonoscopy and biopsy on this patient reached a “diagnosis” of “herbal intoxication,” in the presence of some histological evidence of both acute and chronic inflammation.
In both case reports, the actual underlying diagnosis is not clear. One could construct a differential diagnosis that could explain the complaints of these patients as a consequence of events unrelated to the act of colon cleansing.
While I agree that a clear evidence base to support the widespread practice of colonic irrigation is not available in current scientific literature, the procedure should not be summarily condemned. Many individuals report beneficial outcomes of colon hydrotherapy, even if such data are anecdotal and not archived with consistency.
My principal criticism of this article is that it did not present a complete or balanced perspective on the alleged dangers of the procedures in question. The authors failed to acknowledge that the frequency of reported complications of colon hydrotherapy may be significantly less than those reported with various diagnostic tests, such as barium enema examination, sigmoidoscopy, or colonoscopy.
I encourage your readers not to summarily reject “colon cleansing.” I submit that Mishori et al failed to fulfill the criteria for concluding that the act of colon cleansing is overly dangerous or ineffective when applied in an appropriate or medically indicated manner.
Stephen Holt, MD, DSc
Little Falls, NJ