Original article
Clinical endoscopy
The effect of chewing gum on small-bowel transit time in capsule endoscopy: a prospective, randomized trial

https://doi.org/10.1016/j.gie.2013.08.038Get rights and content

Background

Approximately 1 in 6 capsule endoscopies (CEs) does not visualize the entire small bowel at completion of the examination because of limited battery life.

Objective

To determine whether chewing gum can reduce the small-bowel transit time and increase CE completion rates.

Design

Prospective, single-blind, randomized, controlled trial.

Setting

A tertiary university-affiliated hospital.

Patients

Consecutive patients 19 years of age and older undergoing outpatient small-bowel CE from October 2010 to July 2012 were assessed for eligibility. Those with previous gastric or small-bowel surgery or ileostomy, dysphagia prohibiting capsule ingestion, diabetes mellitus with evidence of end-organ damage, use of narcotics or prokinetics within 5 days before the procedure, clinical hyper-/hypothyroidism, and symptoms suggestive of acute bowel obstruction were excluded.

Intervention

Gum chewing for at least 20 minutes every 2 hours starting at the time of capsule ingestion.

Main Outcome Measurements

Small-bowel transit time, gastric transit time, and completion rate were measured.

Results

Chewing gum did not have any significant effect on gastric transit time (rate ratio 1.06; 95% CI, 0.73-1.55; P = .75), small-bowel transit time (rate ratio 0.91; 95% CI, 0.62-1.35; P = .65), or completion rate (91.67% chewing gum vs 88.71% control, P = .58) of CE.

Limitation

Single-center study involving relatively healthy subjects. Procedures were done on an outpatient basis so participants were not monitored for adherence to protocol.

Conclusions

Chewing gum does not speed up capsule transit or increase completion rate of CE in patients without risk factors for incomplete studies. (Clinical trial registration number: NCT01241825.)

Section snippets

Study design, patient population, and randomization

This is a prospective, single-blinded, randomized controlled trial. Between October 2010 and July 2012, consecutive patients who underwent CE at St. Paul's Hospital (Vancouver, British Columbia, Canada) were evaluated for inclusion. Inclusion criteria include 19 years of age and older and outpatient status. Exclusion criteria include previous gastric and/or small-bowel surgery, presence of an ileostomy, dysphagia prohibiting capsule ingestion, diabetes mellitus with evidence of end-organ

Results

A total of 329 patients underwent small-bowel CE between October 2010 and July 2012. Of these patients, 24 did not meet inclusion criteria because of age or inpatient status. Another 146 patients were excluded from the study based on exclusion criteria, and 37 patients declined to participate in the study (Fig. 1). Therefore, 122 patients were enrolled, 60 of whom were randomly assigned to the chewing gum group. A target sample size was reached. All subjects tolerated the procedure well without

Discussion

The capsule camera traverses the gut passively through bowel peristalsis and gravity. Given its limited battery life, a capsule camera only reaches the cecum approximately 83.5% of the time.2 Numerous potential factors for incomplete CE have been identified, including inpatient status, older age, poor bowel preparation, previous small-bowel surgery,37 and diabetes.38 Chewing gum has been proposed to affect bowel motility via 2 mechanisms: the vagal cholinergic stimulation of the bowel and the

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    DISCLOSURE: All authors disclosed no financial relationships relevant to this publication.

    If you would like to chat with an author of this article, you may contact Dr Enns at [email protected].

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