Can the Breeza drink for MRI bowel preparation cause diarrhea in individuals without Inflammatory Bowel Disease (IBD)?

Can Breeza Cause Diarrhea in People Without IBD?

Yes, Breeza (a sugar alcohol-based flavored beverage) can cause diarrhea in individuals without IBD, as it contains osmotic agents that draw fluid into the bowel lumen—this is an expected physiologic effect of the preparation, not a complication.

Mechanism of Action

• Breeza is a neutral oral contrast agent containing sugar alcohols (osmotic agents) designed specifically to distend the small bowel for MRI enterography 1, 2
• The osmotic properties that make it effective for bowel distension inherently cause fluid retention in the intestinal lumen, which produces loose stools or diarrhea as an intended pharmacologic effect 3, 4
• Patients are instructed to consume 900-1,500 mL of this preparation over 45-60 minutes, with volumes exceeding 1,000 mL providing superior bowel distension 3

Expected Side Effects in All Patients

• The diarrhea or loose stools following Breeza consumption occur regardless of IBD status—this is the mechanism by which the preparation achieves bowel distension 3, 1
• In pediatric studies comparing oral contrast agents, patients consuming Breeza had similar completion rates and tolerability profiles whether or not they had active Crohn's disease, indicating the gastrointestinal effects are not disease-specific 1, 2
• This is not an adverse reaction but rather the expected physiologic response to ingesting large volumes of osmotic agents 3, 4

Clinical Evidence on Tolerability

• In a prospective randomized trial of 66 pediatric patients, 84.8% (28/33) completed the entire Breeza preparation, with patients rating it significantly higher for taste (6.1 vs 2.7 on a 10-point scale) compared to barium sulfate suspension 2
• A separate study of 75 pediatric patients found Breeza had superior taste ratings (2.8) compared to VoLumen barium (1.9), though lower than MiraLAX (3.4), with similar findings in both patients with and without active Crohn's disease 1
• The completion rates and tolerability scores demonstrate that the gastrointestinal effects (including diarrhea) are manageable for most patients regardless of underlying bowel pathology 1, 2

Important Clinical Context

• The transient diarrhea from Breeza resolves after the imaging study is completed and the osmotic agent is eliminated from the gastrointestinal tract 3
• Patients should be counseled that loose stools or diarrhea are expected and temporary, not a sign of intolerance or complication 3, 1
• The key distinction is that this is pharmacologically induced diarrhea from osmotic load, not pathologic diarrhea from mucosal injury or inflammation 3, 4

Contraindications to Consider

• Avoid oral phosphate-containing preparations (not Breeza specifically, but other bowel prep agents) in patients with GFR <60 mL/min/1.73 m² due to nephropathy risk 3, 4
• No specific contraindications exist for Breeza in patients without IBD beyond standard precautions for osmotic bowel preparations 1, 2