Is sugar-free gum permitted during the liquid phase of colonoscopy preparation?

Sugar-Free Gum During Liquid Phase of Colonoscopy Preparation

Sugar-free gum is permitted during the liquid phase of colonoscopy preparation, as it does not negatively impact bowel preparation quality and may improve patient satisfaction with the preparation process. 1

Evidence on Gum Chewing During Colonoscopy Preparation

The 2025 US Multi-Society Task Force on Colorectal Cancer guidelines specifically address this question, noting that chewing gum has been studied in randomized controlled trials and was found to:

• Improve patient satisfaction with bowel preparation regimens (97.4% vs 90.7% among those not chewing gum) 1
• Have no negative impact on the quality of bowel preparation 1, 2

The American Society of Anesthesiologists (ASA) practice guidelines make a conditional suggestion not to delay elective procedures requiring anesthesia in healthy adults who are chewing gum 1. However, it's important to note that patients must remove any gum from their mouths before the procedure 1.

Benefits of Gum Chewing

Several studies have demonstrated potential benefits of gum chewing during colonoscopy preparation:

• Reduced abdominal pain and nausea caused by polyethylene glycol solution 3
• Improved patient tolerance of the bowel preparation process 4
• Shorter time to ingest polyethylene glycol solution 4
• Enhanced bowel motility 5

Practical Recommendations

When incorporating gum chewing into colonoscopy preparation:

1. Use sugar-free gum only
2. Chew for approximately 20 minutes every 2 hours during the liquid phase 2, 3
3. Continue until the beginning of the colonoscopy procedure
4. Remove all gum from the mouth before the procedure begins 1

Important Considerations

• The primary focus should remain on proper bowel preparation using the prescribed purgative regimen
• A split-dose administration of bowel preparation purgatives is strongly recommended for all patients 1
• The second dose should begin 4-6 hours before colonoscopy and be completed at least 2 hours before the procedure 1
• Dietary modifications should be limited to the day before colonoscopy for low-risk patients 1, 6

Conclusion

While sugar-free gum is permitted during the liquid phase of colonoscopy preparation and may improve patient comfort, it should be considered an adjunct to, not a replacement for, proper bowel preparation regimens. The evidence suggests it can enhance the patient experience without compromising preparation quality.