title: Improving of bowel cleansing effect for polyethylene glycol with ascorbic acid using simethicone: A randomized controlled trial.
abstract: OBJECTIVE
  Low-volume polyethylene glycol with ascorbic acid (PEG-Asc) use is reported to be as safe and effective as traditional 4-L polyethylene glycol use. However, PEG-Asc produces bubbles, which cause problems during colonoscopy. Data on the effects of using antifoaming agents such as simethicone with PEG-Asc are lacking. The aim of this CONSORT-prospective, randomized, observer-blinded, controlled trial is to compare the quality of bowel preparation and compliance between PEG-Asc users and PEG-Asc plus simethicone users.
  
  
  METHODS
  Adult outpatients aged 18 to 80 years undergoing colonoscopy were recruited to the study. Two hundred sixty patients were randomly assigned to 1 of 2 treatment arms, PEG-Asc or PEG-Asc plus simethicone. The primary outcome measure was the bowel cleansing quality using Boston bowel preparation scale and bubble scores. The secondary outcome measures were patient tolerability and doctor tolerability.
  
  
  RESULTS
  The simethicone group showed superior cleansing results (6-9 Boston scale scores: 99% vs. 84%, <5% bubble scores: 96% vs. 49%, P < 0.001) and fewer gastrointestinal symptoms (abdominal fullness: 24% vs. 55%, colicky pain: 5% vs. 24%, P < 0.001) than the non-simethicone group. Moreover, endoscopist fatigue during colonoscopy was lower in the simethicone group than in the non-simethicone group (1.31 ± 0.75 vs. 2.97 ± 2.14, P < 0.001).
  
  
  CONCLUSIONS
  PEG-Asc plus simethicone use was more effective and associated with better patient and endoscopist tolerance than PEG-Asc use. Therefore, this combination is recommended as one of the promising methods for bowel preparation before colonoscopy.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Institute of Digestive Disease and Nutrition, Korea University College of Medicine, Seoul, Republic of Korea.
authors.forename: In Kyung
authors.initials: IK
authors.lastname: Yoo
authors.forename: Yoon Tae
authors.initials: YT
authors.lastname: Jeen
authors.forename: Seung Hun
authors.initials: SH
authors.lastname: Kang
authors.forename: Jae Hyung
authors.initials: JH
authors.lastname: Lee
authors.forename: Seung Han
authors.initials: SH
authors.lastname: Kim
authors.forename: Jae Min
authors.initials: JM
authors.lastname: Lee
authors.forename: Hyuk Soon
authors.initials: HS
authors.lastname: Choi
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Kim
authors.forename: Bora
authors.initials: B
authors.lastname: Keum
authors.forename: Hoon Jai
authors.initials: HJ
authors.lastname: Chun
authors.forename: Hong Sik
authors.initials: HS
authors.lastname: Lee
authors.forename: Chang Duck
authors.initials: CD
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000934:Antifoaming Agents / Q000008:administration & dosage*; D001205:Ascorbic Acid / Q000008:administration & dosage*; D002400:Cathartics / Q000008:administration & dosage*; D003113:Colonoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011446:Prospective Studies; D012841:Simethicone / Q000008:administration & dosage*
chemical_list: D000934:Antifoaming Agents; D002400:Cathartics; D011092:Polyethylene Glycols; D012841:Simethicone; D001205:Ascorbic Acid