Surgical Endoscopy

, Volume 33, Issue 12, pp 3899–3909 | Cite as

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

  • Muhammad Moolla
  • Jerry T. DangEmail author
  • Ashley Shaw
  • Thuc Nhi Tran Dang
  • Chunhong Tian
  • Shahzeer Karmali
  • Richard Sultanian
Review Article



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.


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.


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).


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.


Sodium phosphate Biofilm Endoscope Simethicone Colonoscopy 



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

Compliance with ethical standards


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.

Supplementary material

464_2019_7066_MOESM1_ESM.docx (171 kb)
Supplementary material 1 (DOCX 171 kb)


  1. 1.
    Saltzman JR, Cash BD, Pasha SF, Early DS, Raman Muthusamy V, Khashab MA, Chathadi KV, Fanelli RD, Chandrasekhara V, Lightdale JR, Fonkalsrud L, Shergill AK, Hwang JH, Decker GA, Jue TL, Sharaf R, Fisher DA, Evans JA, Foley K, Shaukat A, Eloubeidi MA, Faulx AL, Wang A, Acosta RD (2015) Bowel preparation before colonoscopy. Gastrointest Endosc 81:781–794. CrossRefPubMedGoogle Scholar
  2. 2.
    Winawer SJ (2007) Colorectal cancer screening. Best Pract Res Clin Gastroenterol 21:1031–1048. CrossRefPubMedGoogle Scholar
  3. 3.
    Rex D, Petrini J, Baron T, Chak A, Cohen J, Deal S (2006) Quality indicators for colonoscopy. Am J Gastroenterol 101:1200–1208. CrossRefGoogle Scholar
  4. 4.
    Park S, Lim YJ (2014) Adjuncts to colonic cleansing before colonoscopy. World J Gastroenterol 20:2735–2740. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Brečević L, Bošan-Kilibarda I, Strajnar F (1994) Mechanism of antifoaming action of simethicone. J Appl Toxicol 14:207–211CrossRefGoogle Scholar
  6. 6.
    Benmassaoud A, Parent J (2018) Canadian association of gastroenterology position statement on the impact of simethicone on endoscope reprocessing. J Can Assoc Gastroenterol 1:40–42CrossRefGoogle Scholar
  7. 7.
    Wu L, Cao Y, Liao C, Huang J, Gao F (2011) Systematic review and meta-analysis of randomized controlled trials of Simethicone for gastrointestinal endoscopic visibility. Scand J Gastroenterol. CrossRefPubMedGoogle Scholar
  8. 8.
    Ofstead CL, Wetzler HP, Johnson EA, Heymann OL, Maust TJ, Shaw MJ (2016) Simethicone residue remains inside gastrointestinal endoscopes despite reprocessing. Am J Infect Control 44:1237–1240. CrossRefPubMedGoogle Scholar
  9. 9.
    Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions. Wiley, New YorkGoogle Scholar
  10. 10.
    Wieszczy P, Regula J, Kaminski MF (2017) Adenoma detection rate and risk of colorectal cancer. Best Pract Res Clin Gastroenterol 31:441–446. CrossRefPubMedGoogle Scholar
  11. 11.
    Manes G, Fontana P, De Nucci G, Radaelli F, Hassan C, Ardizzone S (2015) Colon cleansing for colonoscopy in patients with ulcerative colitis: efficacy and acceptability of a 2-L PEG plus bisacodyl versus 4-L PEG. Inflamm Bowel Dis 21:2137–2144. CrossRefPubMedGoogle Scholar
  12. 12.
    Collaboration C (2014) Review manager (Version 5.3) [computer software]. Denmark Nord Cochrane Cent, CopenhagenGoogle Scholar
  13. 13.
    Bai Y, Fang J, Zhao SB, Wang D, Li YQ, Shi RH, Sun ZQ, Sun MJ, Ji F, Si JM, Li ZS (2018) Impact of preprocedure simethicone on adenoma detection rate during colonoscopy: a multicenter, endoscopist-blinded randomized controlled trial. Endoscopy 50:128–136. CrossRefPubMedGoogle Scholar
  14. 14.
    Cesaro P, Hassan C, Spada C, Petruzziello L, Vitale G, Costamagna G (2013) A new low-volume isosmotic polyethylene glycol solution plus bisacodyl versus split-dose 4L polyethylene glycol for bowel cleansing prior to colonoscopy: a randomised controlled trial. Dig Liver Dis 45:23–27. CrossRefPubMedGoogle Scholar
  15. 15.
    Matro R, Tupchong K, Daskalakis C, Gordon V, Katz L, Kastenberg D (2012) The effect on colon visualization during colonoscopy of the addition of simethicone to polyethylene glycol–electrolyte solution: a randomized single-blind study. Clin Transl Gastroenterol 3:e26–e28. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Pontone S, Angelini R, Standoli M, Patrizi G, Culasso F, Pontone P, Redler A (2011) Low-volume plus ascorbic acid vs high-volume plus simethicone bowel preparation before colonoscopy. World J Gastroenterol 17:4689–4695. CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Yoo IK, Jeen YT, Kang SH, Lee JH, Kim SH, Lee JM, Choi HS, Kim ES, Keum B, Chun HJ, Lee HS, Kim CD (2016) Improving of bowel cleansing effect for polyethylene glycol with ascorbic acid using simethicone: a randomized controlled trial. Medicine (U S). CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Zhang S, Zheng D, Wang J, Wu J, Lei P, Luo Q, Wang L, Zhang B, Wang H, Cui Y, Chen M (2018) Simethicone improves bowel cleansing with low-volume polyethylene glycol: a multicenter randomized trial. Endoscopy 50:412–422. CrossRefPubMedGoogle Scholar
  19. 19.
    Zorzi M, Valiante F, Germanà B, Baldassarre G, Coria B, Rinaldi M, Heras Salvat H, Carta A, Bortoluzzi F, Cervellin E, Polo ML, Bulighin G, Azzurro M, Di Piramo D, Turrin A, Monica F (2016) Comparison between different colon cleansing products for screening colonoscopyA noninferiority trial in population-based screening programs in Italy. Endoscopy 48:223–231. CrossRefPubMedGoogle Scholar
  20. 20.
    Valiante F, Bellumat A, De Bona M, De Boni M (2013) Bisacodyl plus split 2-L polyethylene glycol-citrate-simethicone improves quality of bowel preparation before screening colonoscopy. World J Gastroenterol 19:5493–5499. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Gentile M, De Rosa M, Cestaro G, Forestieri P (2013) 2 L PEG plus ascorbic acid versus 4 L PEG plus simethicon for colonoscopy preparation: a randomized single-blind clinical trial. Surg Laparosc Endosc Percutan Tech 23:276–280. CrossRefPubMedGoogle Scholar
  22. 22.
    Lazzaroni M, Petrillo M, Desideri S, Porro GB (1993) Efficacy and tolerability of polyethylene glycol-electrolyte lavage solution with and without simethicone in the preparation of patients with inflammatory bowel disease for colonoscopy. Aliment Pharmacol Ther 7:655–659. CrossRefPubMedGoogle Scholar
  23. 23.
    Parente F, Vailati C, Bargiggia S, Manes G, Fontana P, Masci E, Arena M, Spinzi G, Baccarin A, Mazzoleni G, Testoni PA (2015) 2-Litre polyethylene glycol-citrate-simethicone plus bisacodyl versus 4-litre polyethylene glycol as preparation for colonoscopy in chronic constipation. Dig Liver Dis 47:857–863. CrossRefPubMedGoogle Scholar
  24. 24.
    Repici A, Cestari R, Annese V, Biscaglia G, Vitetta E, Minelli L, Trallori G, Orselli S, Andriulli A, Hassan C (2012) Randomised clinical trial: low-volume bowel preparation for colonoscopy: a comparison between two different PEG-based formulations. Aliment Pharmacol Ther 36:717–724. CrossRefPubMedGoogle Scholar
  25. 25.
    Spada C, Cesaro P, Bazzoli F, Saracco GM, Cipolletta L, Buri L, Crosta C, Petruzziello L, Ceroni L, Fuccio L, Giordanino C, Elia C, Rotondano G, Bianco MA, Simeth C, Consalvo D, De Roberto G, Fiori G, Campanale M, Costamagna G (2017) Evaluation of Clensia®, a new low-volume PEG bowel preparation in colonoscopy: multicentre randomized controlled trial versus 4L PEG. Dig Liver Dis 49:651–656. CrossRefPubMedGoogle Scholar
  26. 26.
    McNally R, Maydonovitch CL, Wong KH (1989) The effect of simethicone on colonic visibility after night-prior colonic lavage. J Clin Gastroenterol 11:650–652. CrossRefPubMedGoogle Scholar
  27. 27.
    Shaver WA, Storms P, Peterson WL (1988) Improvement of oral colonic lavage with supplemental simethicone. Dig Dis Sci 33:185–188. CrossRefPubMedGoogle Scholar
  28. 28.
    McDonald GB, O’Leary R, Stratton C (1978) Pre-endoscopic use of oral simethicone. Gastrointest Endosc 24:283CrossRefGoogle Scholar
  29. 29.
    Kilgore TW, Abdinoor AA, Szary NM, Schowengerdt SW, Yust JB, Choudhary A, Matteson ML, Puli SR, Marshall JB, Bechtold ML (2011) Bowel preparation with split-dose polyethylene glycol before colonoscopy: a meta-analysis of randomized controlled trials. Gastrointest Endosc 73:1240–1245. CrossRefPubMedGoogle Scholar
  30. 30.
    Martel M, Barkun AN, Menard C, Restellini S, Kherad O, Vanasse A (2015) Split-dose preparations are superior to day-before bowel cleansing regimens: a meta-analysis. Gastroenterology 149:79–88. CrossRefPubMedGoogle Scholar
  31. 31.
    Bucci C, Rotondano G, Hassan C, Rea M, Bianco MA, Cipolletta L, Ciacci C, Marmo R (2014) Optimal bowel cleansing for colonoscopy: split the dose! A series of meta-analyses of controlled studies. Gastrointest Endosc 80:566–576. CrossRefPubMedGoogle Scholar
  32. 32.
    Kovaleva J, Peters FTM, van der Mei Mei HC, Degener JE (2013) Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clin Microbiol Rev 26:230–253. CrossRefGoogle Scholar
  33. 33.
    Gastroenterol CO (2016) What level of bowel prep quality requires early repeat colonoscopy: systematic review and meta-analysis of the impact of preparation quality on adenoma detection rate Brian. Am J Gastrointerol 31:81–88. CrossRefGoogle Scholar
  34. 34.
    Altintaş E, Üçbilek E, Sezgin O, Sayici Y (2008) Alverine citrate plus simethicone reduces cecal intubation time in colonoscopy: a randomized study. Turk J Gastroenterol 19:174–179PubMedGoogle Scholar
  35. 35.
    Tongprasert S, Sobhonslidsuk A, Rattanasiri S (2009) Improving quality of colonoscopy by adding simethicone to sodium phosphate bowel preparation. World J Gastroenterol 15:3032–3037. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Faculty of Medicine and DentistryUniversity of AlbertaEdmontonCanada
  2. 2.Department of SurgeryUniversity of Alberta, University of Alberta HospitalEdmontonCanada
  3. 3.Division of GastroenterologyUniversity of AlbertaEdmontonCanada

Personalised recommendations