The role of simethicone in the preparation of upper gastrointestinal endoscopy

This is an automatically translated article.

Posted by Master, Doctor Mai Vien Phuong - Department of Examination & Internal Medicine - Vinmec Central Park International General Hospital
Preparing for upper gastrointestinal endoscopy with Simethicone effectively reduces foam stasis in the esophagus, stomach and duodenum, helping to observe and diagnose small lesions more clearly and accurately. Since then, endoscopic treatment is conducted conveniently and quickly, reducing irritation and discomfort for the patient.

1. What is Simethicone?

Simethicone (Air-X ®) is a drug widely indicated in cases of flatulence, abdominal distension, in addition to the effect of dissolving gastrointestinal foam. The drug can be used for both adults and children with high safety and no drug interactions with other ingredients. Simethicone is popular and cheap. Many authors believe that this is a method of endoscopic preparation with practical efficiency and high applicability. Simethicone has been used in many countries for the preparation of upper gastrointestinal endoscopy because it helps to reduce foam retention.

2. Mechanism of action of Simethicone

With different dosage forms, Simethicone may have some different points in absorption into the body, but some key points can be mentioned in the absorption process of the drug, which can be summarized as follows:
Simethicone It is a liquid with a certain viscosity, light gray color, odorless and tasteless. Research on the structure of Simethicone, it has also been shown that they are also physiologically inert, that is, it is almost not absorbed by the body, nor does it cause gastric acid to decrease or make other substances less bioavailable. use. Therefore, the drug is not converted into other forms, but is completely eliminated in the unchanged form in the feces. About the mechanism of action of the drug on the body: Research by scientists shows that Simethicone has a Silicon dioxide content of about 4 to 7%. Thanks to this ingredient, Simethicone has the effect of reducing the tension at the surface of gas bubbles that appear in the digestive tract, especially gastric juice, chyme and fluid in the intestinal lumen. This effect is necessary because these air bubbles exist, which will cause the abdomen to feel full, difficult to digest, loss of appetite. In some cases of imaging interventions such as X-rays where the bubbles interfere with vision and can give misleading results, Simethicone will help to eliminate these bubbles. Thanks to the above mechanism, we can conclude the following two main effects of Simethicone:
First: The effect of eliminating gas bubbles in the digestive juices, reducing bloating, flatulence, belching, difficulty indigestion, loss of appetite. Second: Use Simethicone before taking X-rays to support the diagnosis of clearer and more accurate images.

3. Uses of Simethicone

With the above effects, Simethicone is indicated for use in the following cases:
Patients with gastroesophageal reflux disease and ulcerative colitis have symptoms of belching, heartburn, reflux. Patients with indigestion, bloating due to excess gas in the digestive tract. Used in combination with antacids (drugs that neutralize stomach acid, which are weak bases) in the treatment regimen for patients with peptic ulcer due to increased acid secretion. Patient prepares for X-ray or gastroscopy or rectal endoscopy.

4. Some major obstacles in gastrointestinal endoscopy

Upper gastrointestinal endoscopy is by far one of the most reliable diagnostic methods for detecting diseases of the esophagus, stomach and duodenum. With that outstanding advantage, endoscopy is developing rapidly with the goal of detecting smaller lesions, at an earlier stage capable of complete healing. In addition to the continuous development of advanced endoscopic techniques, the study of preparation methods for gastrointestinal cleansing always plays an essential role in ensuring that the colonoscopy is conducted quickly and without omission. Small lesions in the esophagus, stomach, and duodenum. In addition to the problem of stale food, bile in the gastrointestinal tract, foam in the upper gastrointestinal tract is one of the main reasons that hinder the observation of this small lesion even after the patient has adhered to fasting. drink before the exam.

5. Grading the degree of foam cleanliness on gastrointestinal endoscopy:

Level A, completely clean of foam Level B, survey area has little foam. department. Need to wash > 100 ml of water to be observed.

6. The role of Simethicone in gastrointestinal endoscopy

Today, upper GI endoscopy continues to evolve, not only as a standard diagnostic test for upper gastrointestinal diseases, but also as a condition for a number of treatments, for example. eg, upper gastrointestinal hemostasis, tumor resection, is important in dilation or stenting of the narrow gastric cavity. However, the use of food, or defoaming and bubbling (derived from gas in the intestinal tract combined with gastric juice, or bile, can cause abdominal pain, impaired visual Therefore, fasting for at least 6-8 hours and/or administration of prokinetic (intravenous erythromycin) or antifoaming (oral simethicone) drugs is recommended prior to application. This method
Preparing for upper gastrointestinal endoscopy with Simethicone effectively reduces foam stasis in the esophagus, stomach and duodenum, helping to observe and diagnose small lesions more clearly and accurately. Since then, endoscopic treatment has been conducted conveniently, quickly, reducing irritation and discomfort for patients.Simethicone has been used in many countries to prepare for upper gastrointestinal endoscopy in diagnosis and treatment.
Many studies by the authors have concluded that this is a method of endoscopic preparation with practical efficiency and high applicability. The authors found that Simethicone significantly reduced the foam on the gastrointestinal tract; the colonoscopy was conducted quickly and smoothly; The endoscopist very rarely needs to perform irrigation for observation and imaging; The patient is significantly more comfortable.
According to the study of gastric cancer by many authors, about 30% of people with gastric cancer have had previous colonoscopy but no lesions were detected. Recently, many articles have reported that, during endoscopic examination, more and more small lesions were detected (the pathology is dysplasia, and early cancer), thanks to the effective use of simethicone, have been conducting endoscopic treatments such as mucosal resection (EMR).
Other studies in the world on the effectiveness of cleansing have also demonstrated the above advantages in the preparation of upper gastrointestinal endoscopy. On the other hand, endoscopists also found that the better improvement of upper gastrointestinal foam has made the endoscopic image clearer, supporting the accurate endoscopic diagnosis, detecting lesions. small, which was previously obscured by the foam factor, affecting the doctor's observation and evaluation, especially in blind and hidden areas such as behind the cardia, behind the pyloric foramen, behind the curvature angle. small of the stomach...

7. Effect of foam on therapeutic endoscopy and the role of Simethicone

In esophageal varices ligation, foam obscures the field of view, making it difficult to accurately identify the varicose veins, leading to more constriction of the mucosa and easy bleeding.
Foam also affects the polypectomy procedure because it is difficult to assess the polyp base when a noose is placed on the polyp, easily penetrates the mucosal layer, and cleaning the foam will limit the omission of polyps, making it difficult to assess the depth of the electric knife. when cutting. In particular, in the case of multiple polyps, to limit missed polyps, the patient does not have to go for endoscopic removal many times.

8. How to mix Simethicone in gastrointestinal endoscopy

Simethicone (Air-X®): mixed in a dose of 1.2ml (80mg) Simethicone with 20ml distilled water. The patient will be carried out upper gastrointestinal endoscopy after 5-10 minutes from the time of drinking the preparation solution for endoscopy.
According to the manufacturer's recommendations, the dose of Simethicone to use for the preparation of an upper gastrointestinal endoscopy in an average adult is 200-400mg. However, the dose of Simethicone 80mg has been tested on how many patients and the results of oral administration show that more than 90-95% of cases achieve the ideal level of foam clearance when observing lesions in the esophagus, antrum, and bulb. colon. Therefore, according to some authors, the benefit obtained is probably not significant if the additional dose of Simethicone as recommended by the manufacturer will be negligible.

9. Which area of ​​the stomach is prone to foaming?

Many authors found that the high body and gastric bulge are the lowest areas of the stomach in the classic upper gastrointestinal endoscopy position (the patient is lying on the left side). Besides, mucus often accumulates here, making it difficult to see. In addition to foam, mucus is also a cause of great limitation for the observation and assessment of lesions. In addition, according to Chang (2007) showed that the use of Pronase enzyme or N-acetyl-cysteine ​​significantly reduces mucus and helps to better observe the gastrointestinal mucosa.

9. Side effects of Simethicone in gastrointestinal endoscopy

As mentioned in the effect of Simethicone, Simethicone is almost not absorbed or changed in the body, but excreted in the feces in an intact form. Therefore, the drug has almost no side effects to the body. Simethicone is also in an odorless and tasteless form, so patients using it will not experience any nausea or discomfort. The following clinical trials have been performed that can prove the safety of the drug:
When given orally to lab rats, injections under different methods (such as subcutaneous or subperitoneal) gave the same results. safe, not a single mouse died. When the drug was administered to 130 children to demonstrate its safety, none of them showed any gastrointestinal disturbances or abnormalities, and in some children, vomiting and loss of appetite were reduced.

10. Interaction of Simethicone with other drugs during gastrointestinal endoscopy

Similar to other drugs, Simethicone may interact with active ingredients or medications. So tell your doctor about all the prescriptions, including supplements, that you are taking. Simethicone can decrease the absorption of thyroid medications (eg Levothyroxine). Theoretically, if you're taking thyroid medication, you should wait at least 4 hours before using one containing simethicone.
However, the dose used for Simethicone in gastrointestinal endoscopy is 80mg, and only a single dose, so these interactions are insignificant and not cause for concern.
Simethicone's inert nature also suggests that they have very limited interactions with other substances. However, if the patient has used Simethicone before the endoscopy and finds any interactions that cause discomfort, it is necessary to notify the treating doctor for timely advice before the endoscopy. Preparation for upper gastrointestinal endoscopy with Simethicone effectively reduces foam stasis in the esophagus, stomach and duodenum. It is a safe, simple, quick preparation and low cost method. This is also a method to help observe and diagnose small lesions more clearly and accurately. Since then, endoscopic treatment is conducted conveniently and quickly, reducing irritation and discomfort for the patient.
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References
Hoang Long et al. Study on the foam-dissolving effect of simethicone in the preparation of upper gastrointestinal endoscopy. City Medicine. Ho Chi Minh, Vol. 15, Supplement of No. 1, 2011 Banerjee B (1992). Effectiveveness of preprocedure simethicone drink in improving visibility during esophagogastroduodenoscopy: a double-blind, randomized study. J Clin Gastroenterol. Bertoni G (1992). Randomized placebo-controlled trial of oral liquid simethicone prior to upper gastrointestinal endoscopy. Chang CC et al (2007). Premedication with pronase or N-acetylcysteine ​​visibility during gastroendoscopy: An endoscopist-blinded, prospective, randomized study. World J Gastroenterol; 13(3): 444-4. Vidal 2005, 22. SEE MORE
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