Colon Hydrotherapy Within an Integrated Gastroenterological Management Pathway: A Prospective Pilot Study of Gastrointestinal and Extraintestinal Symptoms in Patients with Chronic Gastrointestinal Disorders

Background/Objectives: Transanal irrigation (TAI) is an established bowel-emptying strategy for selected patients with bowel dysfunction, whereas evidence on Colon Hydrotherapy (CHT) in chronic gastrointestinal disorders remains limited. This pilot study characterized patients undergoing CHT within specialist gastroenterological care and prospectively evaluated gastrointestinal and extraintestinal symptoms, lifestyle modifications, concomitant treatments, and safety over 12 months. Methods: Consecutive adults with chronic gastrointestinal disorders, including Irritable Bowel Syndrome (IBS) and IBS-like disorders, underwent CHT within an individualized gastroenterological management pathway. Symptoms were assessed using a 44-item modified Gastrointestinal Symptom Rating Scale at baseline (T0), 7 days after the first CHT session (T1), and 12 months thereafter (T2). Longitudinal changes were analyzed using linear mixed-effects models. Results: Of 81 enrolled patients, 40 completed all assessments. Overall, 38/44 (86.4%) symptoms showed a significant time effect, predominantly between T0 and T1. Significant time effects were observed across gastrointestinal (14/16, 87.5%), general well-being and systemic (11/13, 84.6%), gynecological (5/6, 83.3%), and urological (8/9, 88.9%) domains. At T2, 36/44 (81.8%) symptoms remained significantly improved versus baseline. The greatest gastrointestinal improvements involved bloating, incomplete evacuation, straining, abdominal pain, hard stools, and reduced bowel movements. Fluid intake and alcohol consumption improved, while macrogol and glycerol suppositories use increased. No clinically significant CHT-related adverse events were observed or reported during the 120 documented CHT procedures performed in the 40 participants included in the longitudinal analysis. Among the remaining 41 enrolled participants, no procedure-related complications or problems were reported in routine clinical care, although a reliable total number of procedures and comparable procedure-level safety data were unavailable. Preliminary safety findings are encouraging, although available data do not allow definitive conclusions regarding the procedural safety of CHT. Conclusions: Symptom improvements were observed after 7 days and confirmed over 12 months in patients managed within an individualized, multimodal gastroenterological pathway that included CHT, pharmacological and dietary management, lifestyle modifications, and specialist follow-up. Although the uncontrolled pilot design and limited longitudinal sample preclude definitive conclusions regarding the specific contribution of CHT, the findings support further investigation of its potential role within integrated gastroenterological care. Controlled studies are warranted to confirm these preliminary observations.