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Simethicone decreases bloating and improves bowel preparation effectiveness: a systematic review and meta-analysis

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Abstract

Background

Simethicone is an adjunct frequently used during bowel preparation before colonoscopy and currently there is no consensus on whether it should be recommended in standard bowel preparation. We performed a systematic review and meta-analysis to determine the effect simethicone has on bowel cleanliness, adenoma detection rate (ADR), and tolerability.

Methods

We searched the literature for studies that compared colon cleansing of patients that received standard bowel preparation alone and in combination with simethicone prior to colonoscopy. The primary outcomes were colon cleanliness, ADR, and tolerability.

Results

Sixteen randomized controlled trials with 5630 patients were included in meta-analysis. Overall, polyethylene glycol (PEG) with simethicone improves colon cleansing compared with PEG alone (odds ratio [OR] 1.48, CI 1.11 to 1.97, P = 0.008). This improvement was seen for single dosing (OR 1.83, CI 1.20 to 2.79, P = 0.005) but not for split dosing (OR 1.32, CI 0.72 to 2.43, P = 0.38). Overall, simethicone had no effect on ADR (OR 1.22, CI 0.81 to 1.83, P = 0.33), but in patients receiving single dosing, simethicone significantly increased ADR (OR 1.96, CI 1.22 to 3.16, P = 0.005). The rates of nausea (OR 0.96, CI 0.75 to 1.24, P = 0.75), vomiting (OR 1.00, CI 0.69 to 1.44, P = 0.99), and abdominal pain (OR 0.69, CI 0.40 to 1.18, P = 0.17) were not significantly different between PEG and PEG + simethicone cohorts. For abdominal bloating, the PEG cohort had greater odds of experiencing bloating than the PEG + simethicone cohort (OR 2.33, CI 1.70 to 3.20, P < 0.00001).

Conclusions

Simethicone improves colon cleanliness and ADR; however, this improvement is not seen in patients receiving split-dose PEG. Furthermore, simethicone decreases abdominal bloating but has no effect on nausea, vomiting, and abdominal pain. Simethicone may be a useful bowel preparation adjunct in patients unable to receive split-dose PEG.

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Funding

The study was funded $6000 by the Department of Surgery Summer Studentship from the Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.

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Author notes

  1. Muhammad Moolla and Jerry T. Dang are co-first authors.

Authors and Affiliations

  1. Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada

    Muhammad Moolla

  2. Department of Surgery, University of Alberta, University of Alberta Hospital, 8440, 112 Street NW, Edmonton, AB, T6G 2B7, Canada

    Jerry T. Dang, Ashley Shaw, Chunhong Tian & Shahzeer Karmali

  3. Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada

    Thuc Nhi Tran Dang & Richard Sultanian

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  1. Muhammad Moolla
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Correspondence to Jerry T. Dang.

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Dr. Sultanian serves as a consultant for Boston Scientific. Muhammad Moolla and Drs. Dang, Shaw, Dang, Tian, and Karmali have no conflicts of interest or financial ties to disclose.

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Moolla, M., Dang, J.T., Shaw, A. et al. Simethicone decreases bloating and improves bowel preparation effectiveness: a systematic review and meta-analysis. Surg Endosc 33, 3899–3909 (2019). https://doi.org/10.1007/s00464-019-07066-5

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