A217 SIMETHICONE DECREASES BLOATING AND IMPROVES BOWEL PREPARATION EFFECTIVENESS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Bibliographic record
Abstract
We performed a systematic review and meta-analysis to determine if the addition of simethicone to bowel preparations prior to colonoscopy had an impact on bowel cleanliness and patient tolerability. Simethicone is an adjunct frequently used but there is currently no consensus on whether it should be recommended for routine use in combination with standard bowel preparations. Furthermore, mounting evidence suggests that simethicone adheres to the lining of the working channel on some of the endoscopes despite reprocessing, leading to the formation of biofilms. Given conflicting evidence regarding the effectiveness of simethicone as an adjunct to bowel preparation combined with recent data suggesting simethicone may contribute to biofilm formation, it is important to reassess the potential benefits of simethicone when added to bowel preparation regimes prior to colonoscopy. 1. Determine the effectiveness of simethicone as an adjunct to bowel preparation on bowel cleanliness A comprehensive search was conducted for studies that compared colon cleansing of patients that received standard bowel preparation alone and in combination with simethicone prior to colonoscopy. Only randomized controlled trials were included. The primary outcomes were colon cleanliness and tolerability. Meta-analysis was performed to compare the number of successful bowel preparations amongst patients receiving polyethylene glycol (PEG) versus patients receiving PEG + simethicone. For tolerability, rates of nausea, vomiting, abdominal pain, and abdominal bloating were compared amongst patients receiving PEG versus patients receiving PEG + simethicone. Sixteen randomized controlled trials with 5630 patients were included in meta-analysis. Overall, PEG with simethicone improved colon cleansing compared with PEG alone (OR 1.48, CI 1.11 to 1.97, P = 0.008). This improvement was seen in patients receiving single dosing (OR 1.83, CI 1.20 to 2.79, P = 0.005) but not in patients receiving split dosing (OR 1.32, CI 0.72 to 2.43, P = 0.38). 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 < .00001). Simethicone, when combined with PEG, resulted in superior colon cleanliness compared to PEG alone. However, this improvement was not seen in patients receiving split-dose PEG, which is now the standard of care. Furthermore, simethicone decreased abdominal bloating but has no effect on nausea, vomiting, and abdominal pain. Figure 1. Successful bowel preparation rates comparing PEG versus PEG + Simethicone None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.021 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.016 | 0.043 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".