Abstract Background: Optimal mucosal visibility during esophagogastroduodenoscopy (EGD) is critical for diagnostic accuracy but is often impaired by the presence of mucus and bubbles. This study aimed to compare the efficacy and safety of four premedication regimens for mucosal visualization during sedated EGD. Methods: A double-blind randomized controlled trial was conducted at the Endoscopy Unit of Dr. Zainoel Abidin General Hospital, Banda Aceh, Indonesia, from January to December 2024. Patients scheduled for elective diagnostic EGD were randomly assigned to: Group 1 (simethicone 40 mg at 30 minutes before the procedure), Group 2 (simethicone 40 mg + 100 mL 5% sodium bicarbonate at 2 hours), Group 3 (simethicone 40 mg + N-acetylcysteine 600 mg in 100 mL water at 2 hours), or Group 4 (all three agents at 2 hours). Primary outcomes were mucosal visibility (6-site, 3-point scoring system with lower scores indicating superior mucosal visibility); procedural metrics (irrigation volume and duration); and safety (the lowest recorded SpO₂%). Data were analyzed using ANOVA or Kruskal–Wallis for continuous variables, and Chi-square or Fisher’s exact test for categorical variables, with post hoc testing as applicable. Results: A total of 168 patients were randomized into four groups (n=42 each). Groups 3 and 4 showed superior mucosal visibility compared to Groups 1 and 2 (p=0.004), with no significant difference between Groups 3 and 4. Irrigation volume differed significantly (p=0.018), lowest in Group 4. Group 3 had the shortest procedure time (3.1 ± 1.2 minutes), significantly more efficient than Groups 1 and 2, but similar to Group 4. Oxygen saturation was slightly lower in Group 3 (p<0.005), though all groups remained within safe clinical limits. Conclusions: Simethicone and N-acetylcysteine given two hours before endoscopy effectively enhanced mucosal visibility and procedural efficiency without compromising safety, offering a practical alternative to more complex regimens.
Esophagogastroduodenoscopy ; Mucosa visibility ; Premedication ; Simethicone ; N-acetylcysteine

Aims: Capsicum annuum (pepper) is one of the most important crops in the world. It contains an impressive list of phytonutrients that were found to have disease-preventing and health-promoting properties. Today, they are grown widely in many parts of the world as an important commercial crop. However, fungal infection is the main problem that leads to the common pepper disruptive disease, known as the Anthracnose, which lowers the yields of this plant. Therefore, this study was conducted to determine the growth, enzymatic antioxidant specific activities of catalase (CAT), ascorbate peroxidase (APX), and guaiacol peroxidase (g-POD) as well as non-enzymatic antioxidants including ascorbic acid, α-tocopherol and carotenoids content in C. annuum as a response to the fungal infections by Colletotrichum capsici. Methodology and results: The assays were conducted at 0, 1, 2, 3, 4 and 5 weeks of fungal treatment periods. The results showed that plant growth (plant height, leaves number, length and width, chlorophyll content) was significantly lower in treated plants compared to controls. The CAT specific activity increased drastically at the early stages of the experiment and decreased thereafter. In contrast, the APX and g-POD specific activity were initially lower, but increased significantly at the later stages of the experiment. For the non-enzymatic antioxidants, the amount of ascorbic acid, α- tocopherol and carotenoids content were significantly higher at the first week of treatment and slowly reduced afterwards. Conclusion, significance and impact of study: This study shows that fungal infection inhibited the growth of pepper plants and the enzymatic and non-enzymatic antioxidants worked in concert to fight against the stress caused by the fungal infection, with their different specific roles in removing and reducing the reactive oxygen species in stress condition.
Capsicum