How is gastric preparation for endoscopic therapy with simethicone discovered?

Posted by Master, Doctor Mai Vien Phuong - Department of Examination & Internal Medicine - Vinmec Central Park International General Hospital

The use of food or defoaming and bubbling (derived from intestinal gas in combination with gastric juice, or bile) can cause abdominal pain, visual mucosal impairment and affect to diagnostic accuracy. Therefore, fasting for at least 6-8 hours and/or administration of prokinetic (intravenous erythromycin) or anti-foaming (oral simethicone) drugs is recommended prior to the application of gastroscopy.

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 characterized by its popularity and low cost. 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.

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 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 when the patient has adhered to fasting. drink before the exam.

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, quickly, reducing irritation and discomfort for the patient. 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. In fact, in many studies, the authors found that Simethicone significantly reduced the foam on the gastrointestinal tract; the colonoscopy was conducted quickly and conveniently; The endoscopist very rarely has to perform irrigation for observation and imaging; The patient is significantly more comfortable.
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 tumors. Small lesions that were 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 border angle. small curvature of the stomach...

In the 1950s, oral solution of simethicone was noticed as an anti-foaming agent in its earlier use in uncontrolled studies. Subsequently, two small randomized double-blind studies, conducted in 1967 and 1978, showed that pre-endoscopic administration of simethicone could significantly reduce the amount of air bubbles and obscuring bubbles. In 1992, Bertoni et al conducted a randomized double-blind placebo-controlled study with 330 participants, and showed that simethicone 65 mg or 195 mg in 90 ml of water was administered before endoscopy. Upper digestive helps to enhance endoscopic visibility by; gradually reduce the obscuring air bubbles and bubbles in the stomach and duodenum. The results also showed that simethicone significantly reduced the number of patients requiring adjuvant simethicone for gastrointestinal cleansing.
Then, in 2009, a placebo-controlled, double-blind, randomized controlled trial was performed by Keeratichananont et al., with 121 participants in upper gastrointestinal endoscopy (EDG), group given simethicone solution (2 ml equivalent to 133.3 mg) or placebo group with 60 ml of water, 15-30 minutes before upper gastrointestinal endoscopy.
The researchers showed that the simethicone solution group significantly enhanced endoscopic visibility in all areas of the upper gastrointestinal tract compared with the placebo group, as demonstrated by a reduction in the number of average cumulative score of air bubbles and bubbles (6.83 + 2.4 vs 11.05 + 2.6, p < 0.001). Furthermore, the number of patients who required adjuvant simethicone for clearance was significantly lower (17.5% vs 74.1%, p < 0.001) and the mean of adjuvant cleaning sessions helped The remaining obscuring bubbles were shorter (0 s vs. 19 s, p < 0.001), corresponding to the simethicone group. The results showed that simethicone significantly enhanced endoscopic compatibility by showing a higher proportion of good to very good endoscopic visibility in this group compared with the placebo group (70.0%) compared with 15.4%, p < 0.001). In addition, patients' self-reported severity of postoperative abdominal pain, nausea, and vomiting were also lower in the simethicone group, as was no significant difference in adverse events between the groups. research.

In 2011, Ahsan et al conducted a double-blind, randomized, placebo-controlled trial of 173 patients in which to evaluate the efficacy of Simethicone (40 mg) chewable tablets in a previously administered method. with 30ml of water within 15-30 minutes before upper gastrointestinal endoscopy. They observed that simethicone was able to significantly reduce the amount of gas in the stomach and shorten the time of endoscopy better than placebo.
In 2014, Chang et al conducted a targeted study in 1,849 patients to evaluate the efficacy of pre-anesthesia with 100 mg simethicone solution alone compared with a combination of 100 mg simethicone and 200 mg of simethicone. mg N-acetylcysteine ​​in 100 ml of water before upper gastrointestinal endoscopy. This study demonstrated that 100 mg of simethicone alone could significantly improve endoscopic visibility compared with the combination of these two drugs. Recently, a meta-analysis as well as a systematic review from ten targeted studies, involving 1,541 patients by Chen et al., confirmed that there was a statistically significant improvement in Visibility of endoscopy with pre-anesthesia use simethicone in at least 30ml of water prior to upper gastrointestinal endoscopy.

Simethicone is statistically used in gastrointestinal cleansing, has proven effective in breaking up air bubbles and bubbles during upper gastrointestinal endoscopy. Furthermore, pre-endoscopic administration of simethicone may enhance endoscopic visibility in all regions of the upper gastrointestinal tract, improve both endoscopic outcome and patient satisfaction, in addition to shortening further time taking simethicone adjuvant gastrointestinal cleansing. Therefore, oral simethicone has been shown to be a good antifoam agent for upper gastrointestinal endoscopy. This method is safe, simple, quick to prepare and low in cost. This is also a method to help observe and diagnose small lesions more clearly and accurately, from which, endoscopic treatment is conducted smoothly and quickly, reducing irritation and discomfort for patients.
Vinmec International General Hospital with a system of modern facilities, medical equipment and a team of experts and doctors with many years of experience in medical examination and treatment, patients can rest assured to visit examination and treatment at the Hospital.

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. S. Keeratichananont, W. Keeratichananon. The Role of Simethicone in Upper Gastrointestinal Endoscopy and Functional Dyspepsia Duodenitis. The Medical news. Volume 18, No. 462, October 2016 Chang CC et al (2007). Premedication with pronase or N-acetylcysteine ​​negative visibility during gastroendoscopy: An endoscopist-blinded, prospective, randomized study. World J Gastroenterol; 13(3): 444-4.

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