Efficacy and safety of gum chewing in adjunct to high-dose senna for bowel cleansing before colonoscopy: a single-blind randomized controlled trial.

BACKGROUND/AIMS: Inadequate bowel cleaning leads to a suboptimal colonoscopic examination. Gum chewing has been reported to have a favorable effect on postoperative bowel functions. We conducted this study to establish if gum chewing added to high-dose senna before colonoscopy promotes bowel cleaning. PATIENTS AND METHODS: In this randomized controlled study, consecutive outpatients scheduled for elective colonoscopy were randomized into two groups. Group 1 patients (n = 65) used senna solution 150 mL (300 mg senna) the night before colonoscopy. The patients also used sennoside tablet 80 mg daily for 3 days before the colonoscopy. Patients in group 2 (n = 64) were additionally advised to chew sugarless gum half an hour three-times daily after meals for these 3 days. The overall quality of colonoscopy cleaning was evaluated using the Aronchick scale by a single endoscopist who was blinded to the intervention. Difficulty of procedure, patients' tolerance, and adverse events were also evaluated. RESULTS: A total 129 patients were enrolled in the study. Superior cleaning was found in gum chewing group when compared with other group particularly in the cecum and ascending colon. Cecal intubation time was significantly shorter in the gum-chewing group (8.6 ± 5.1 and 7.1 ± 2.8 min, P = 0.03). Adverse events were more common in group 1 compared to the gum-chewing group. CONCLUSIONS: Gum chewing enhances colonoscopy bowel preparation quality. Moreover, it is a physiologically sound, safe, and an inexpensive part of the colonoscopy bowel preparation. Gum chewing could be advised in addition to high-dose senna containing bowel preparation.

The protective effect of Echinacea spp. (Echinacea angustifolia and Echinacea purpurea) in a rat colitis model induced by acetic acid.

Ulcerative colitis (UC) is a chronic disease that causes an inflammatory condition in the colon. Several cytokines, including tumor necrosis factor alpha (TNF-α), interleukin 1 beta (IL-1ß) and transforming growth factor beta (TGF-ß) are crucial components of these inflammatory pathways. New therapeutic strategies are needed for improved clinical outcomes in UC and with less adverse effects. That is why alternative therapies such as herbal remedies are increasingly being used with favorable effects in the treatment of UC. Hence, in the present study, we aimed to evaluate the protective effect of Echinacea spp in an experimental rat colitis model induced by acetic acid (AA). Acetic acid was given via a rectal route to induce acute colitis in rats. Rats were placed in four groups: control, Echinacea, Echinacea-colitis and colitis. Tumor necrosis factor alpha, IL-1ß and TGF-ß levels were measured. Histopathological comparison of the groups was also performed. The disease activity index (DAI) was significantly higher in the colitis group compared to the control, Echinacea and Echinacea-colitis groups (p<0.001). There was no significant difference between the DAI of control, Echinacea and Echinacea-colitis groups (p>0.07). The inflammatory mediators IL-1ß and TNF-α were significantly elevated in the colitis group compared to the other groups (p<0.007, <0.001 respectively). Therefore, Echinacea spp. may likely have some therapeutic favorable effects in the management of UC.