What are the alternatives to Simethicone (Dimethicone)?

From the Guidelines

Simethicone alternatives, such as peppermint oil, ginger, fennel seeds, and activated charcoal, can be effective for gas relief, but in the context of endoscopy, the American Society for Gastrointestinal Endoscopy guidelines suggest using the lowest concentration and smallest volume of simethicone if required 1. When considering alternatives to simethicone, it's essential to prioritize methods that reduce gas bubbles during endoscopy without compromising the effectiveness of the procedure.

• Natural alternatives like peppermint oil, ginger, and fennel seeds can help relax intestinal muscles and improve digestion, but their effectiveness in reducing gas bubbles during endoscopy is not well-established.
• Activated charcoal, on the other hand, can absorb excess gas in the digestive tract, but its use in endoscopy settings is not recommended due to potential interference with the procedure. In the context of endoscopy, using the lowest concentration (0.5 mL simethicone in 99.5 mL water; 0.5 % v/v; 10 mg/100 mL) and smallest volume of simethicone is recommended if simethicone is required to be administered through the endoscope 1. It's crucial to note that standard reprocessing protocols may not effectively remove simethicone from the working channel, highlighting the need for careful consideration when using simethicone or its alternatives in endoscopy settings 1.

From the Research

Simethicone Alternatives

• Alpha-galactosidase is an enzyme that can reduce intestinal gas production and may be used as an alternative to simethicone 2.
• Alpha-galactosidase has been shown to improve sonographic visualization of abdominal organs in patients with excessive intestinal gas, suggesting its potential as a simethicone alternative 3.
• Activated charcoal is another option that has been used in combination with simethicone to improve dyspeptic symptoms, and may be considered as an alternative 4, 5.

Mechanism of Action

• Alpha-galactosidase works by breaking down galactosides in the gut, reducing gas production and alleviating symptoms such as bloating and flatulence 2, 6.
• Activated charcoal may help to absorb gas and reduce symptoms, although its exact mechanism of action is not fully understood 4, 5.

Efficacy

• Studies have shown that alpha-galactosidase and activated charcoal can be effective in reducing symptoms of dyspepsia and improving quality of life 3, 4, 2, 5.
• The combination of simethicone, activated charcoal, and magnesium oxide has also been shown to be effective in functional dyspepsia 5.