Clin Nutr Res.  2014 Jul;3(2):134-141. 10.7762/cnr.2014.3.2.134.

Coffee Enema for Preparation for Small Bowel Video Capsule Endoscopy: A Pilot Study

• Kim ES
• Chun HJ
• Keum B
• Seo YS
• Jeen YT
• Lee HS
• Um SH
• Kim CD
• Ryu HS

• KMID: 2279559
• DOI: http://doi.org/10.7762/cnr.2014.3.2.134

Abstract

Coffee enemas are believed to cause dilatation of bile ducts and excretion of bile through the colon wall. Proponents of coffee enemas claim that the cafestol palmitate in coffee enhances the activity of glutathione S-transferase, an enzyme that stimulates bile excretion. During video capsule endoscopy (VCE), excreted bile is one of the causes of poor preparation of the small bowel. This study aimed to evaluate the feasibility and effect of coffee enema for preparation of the small bowel during VCE. In this pilot study, 17 of 34 patients were assigned to the coffee enema plus polyethylene glycol (PEG) 2 L ingestion group, whereas the 17 remaining control patients received 2 L of PEG only. The quality of bowel preparation was evaluated in the two patient groups. Bowel preparations in the proximal segments of small bowel were not differ between two groups. In the mid and distal segments of the small intestine, bowel preparations tend to be better in patients who received coffee enemas plus PEG than in patients who received PEG only. The coffee enema group did not experience any complications or side effects. Coffee enemas may be a feasible option, and there were no clinically significant adverse events related to coffee enemas. More prospective randomized studies are warranted to improve small bowel preparation for VCE.

Keyword

Coffee; Enema; Polyethylene glycol; Small bowel preparation; Video capsule endoscopy

MeSH Terms

Bile
Bile Ducts
Capsule Endoscopy*
Coffee*
Colon
Dilatation
Eating
Enema*
Glutathione Transferase
Humans
Intestine, Small
Pilot Projects*
Polyethylene Glycols
Coffee
Glutathione Transferase
Polyethylene Glycols

Figure

• 

  Figure 1 Comparisons of fluid transparency between the polyethylene glycol (PEG)-only and coffee enema with PEG groups. The grades of the coffee enema with PEG group were significantly better than those of the PEG-only group in the mid (B) and distal (C) small bowel segments and the terminal ileum (D) (p = 0.04, p = 0.001, and p = 0.007, respectively). No significant differences were found between the two groups for the proximal small bowel segment (A). The figures in the bars indicate the number of patients.

• 

  Figure 2 Video capsule images show the difference in small bowel preparation between the coffee enema with PEG (bottom) and PEG-only groups (top).

• 

  Figure 3 Comparisons of mucosal disturbance due to air bubbles in the polyethylene glycol (PEG)-only and coffee enema with PEG groups. The degree of mucosal disturbance in each intestinal segment was comparable between the two groups (A, proximal small bowel segment; B, mid small bowel segment; C, distal small bowel segment; D, terminal ileum). The figures in the bars indicate the number of patients.

Reference

1. Rokkas T, Papaxoinis K, Triantafyllou K, Pistiolas D, Ladas SD. Does purgative preparation influence the diagnostic yield of small bowel video capsule endoscopy?: a meta-analysis. Am J Gastroenterol. 2009; 104:219–227.

2. Kotwal VS, Attar BM, Gupta S, Agarwal R. Should bowel preparation, antifoaming agents, or prokinetics be used before video capsule endoscopy? A systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2014; 26:137–145.

3. Ladas SD, Triantafyllou K, Spada C, Riccioni ME, Rey JF, Niv Y, Delvaux M, de Franchis R, Costamagna G. ESGE Clinical Guidelines Committee. European Society of Gastrointestinal Endoscopy (ESGE): recommendations (2009) on clinical use of video capsule endoscopy to investigate small-bowel, esophageal and colonic diseases. Endoscopy. 2010; 42:220–227.

4. Wi JH, Moon JS, Choi MG, Kim JO, Do JH, Ryu JK, Shim KN, Lee KJ, Jang BI, Chun HJ. Korea Gut Image Study Group. Bowel preparation for capsule endoscopy: a prospective randomized multicenter study. Gut Liver. 2009; 3:180–185.

5. Esaki M, Matsumoto T, Kudo T, Yanaru-Fujisawa R, Nakamura S, Iida M. Bowel preparations for capsule endoscopy: a comparison between simethicone and magnesium citrate. Gastrointest Endosc. 2009; 69:94–101.

6. Postgate A, Tekkis P, Patterson N, Fitzpatrick A, Bassett P, Fraser C. Are bowel purgatives and prokinetics useful for small-bowel capsule endoscopy? A prospective randomized controlled study. Gastrointest Endosc. 2009; 69:1120–1128.

7. Dai N, Gubler C, Hengstler P, Meyenberger C, Bauerfeind P. Improved capsule endoscopy after bowel preparation. Gastrointest Endosc. 2005; 61:28–31.

8. Viazis N, Papaxoinis K, Vlachogiannakos J, Efthymiou A, Theodoropoulos I, Karamanolis DG. Is there a role for second-look capsule endoscopy in patients with obscure GI bleeding after a nondiagnostic first test? Gastrointest Endosc. 2009; 69:850–856.

9. Teekachunhatean S, Tosri N, Rojanasthien N, Srichairatanakool S, Sangdee C. Pharmacokinetics of caffeine following a single administration of coffee enema versus oral coffee consumption in healthy male subjects. ISRN Pharmacol. 2013; 2013:147238.

10. Cassileth B. Gerson regimen. Oncology (Williston Park). 2010; 24:201.

11. Watts JC. Not such distant mirrors. Coffee enemas may be effective shock treatment. BMJ. 2000; 320:383.

12. Teekachunhatean S, Tosri N, Sangdee C, Wongpoomchai R, Ruangyuttikarn W, Puaninta C, Srichairatanakool S. Antioxidant effects after coffee enema or oral coffee consumption in healthy Thai male volunteers. Hum Exp Toxicol. 2012; 31:643–651.

13. Gerson M. The cure of advanced cancer by diet therapy: a summary of 30 years of clinical experimentation. Physiol Chem Phys. 1978; 10:449–464.

14. Min BH, Chang DK, Kim BJ, Lee IS, Choi MG. Does back-to-back capsule endoscopy increase the diagnostic yield over a single examination in patients with obscure gastrointestinal bleeding? Gut Liver. 2010; 4:54–59.

15. Viazis N, Sgouros S, Papaxoinis K, Vlachogiannakos J, Bergele C, Sklavos P, Panani A, Avgerinos A. Bowel preparation increases the diagnostic yield of capsule endoscopy: a prospective, randomized, controlled study. Gastrointest Endosc. 2004; 60:534–538.

16. Niv Y, Niv G, Wiser K, Demarco DC. Capsule endoscopy - comparison of two strategies of bowel preparation. Aliment Pharmacol Ther. 2005; 22:957–962.

17. Ben-Soussan E, Savoye G, Antonietti M, Ramirez S, Ducrotté P, Lerebours E. Is a 2-liter PEG preparation useful before capsule endoscopy? J Clin Gastroenterol. 2005; 39:381–384.

18. Park SC, Keum B, Seo YS, Kim YS, Jeen YT, Chun HJ, Um SH, Kim CD, Ryu HS. Effect of bowel preparation with polyethylene glycol on quality of capsule endoscopy. Dig Dis Sci. 2011; 56:1769–1775.

19. Green S. A critique of the rationale for cancer treatment with coffee enemas and diet. JAMA. 1992; 268:3224–3227.

20. Jones LE, Norris WE. Rectal burn induced by hot coffee enema. Endoscopy. 2010; 42:Suppl 2. E26.

21. Sashiyama H, Hamahata Y, Matsuo K, Akagi K, Tsutsumi O, Nakajima Y, Takaishi Y, Takase Y, Arai T, Hoshino T, Tazawa A, Fu KI, Tsujinaka Y. Rectal burn caused by hot-water coffee enema. Gastrointest Endosc. 2008; 68:1008.

22. Lee CJ, Song SK, Jeon JH, Sung MK, Cheung DY, Kim JI, Kim JK, Lee YS. Coffee enema induced acute colitis. Korean J Gastroenterol. 2008; 52:251–254.

23. Eisele JW, Reay DT. Deaths related to coffee enemas. JAMA. 1980; 244:1608–1609.

24. Margolin KA, Green MR. Polymicrobial enteric septicemia from coffee enemas. West J Med. 1984; 140:460.

25. Keum B, Jeen YT, Park SC, Seo YS, Kim YS, Chun HJ, Um SH, Kim CD, Ryu HS. Proctocolitis caused by coffee enemas. Am J Gastroenterol. 2010; 105:229–230.