Infant colic or colic is a disorder of brain-gut interactions in infants less than 5 months of age. An infant with colic has bouts of prolonged crying without organic or environmental cause. Simethicone is an over-the-counter medication often prescribed in the outpatient setting as well as the NICU. This column provides an overview of colic, describes the Rome Criteria for colic in practice and research, discusses the gut-brain axis in neonatal development, reviews the pharmacology of simethicone, and reviews the evidence around the use of simethicone for colic.

Simethicone is a silicone-based antiflatulent agent widely used for the symptomatic management of gastrointestinal complaints associated with excessive gas, including bloating, flatulence, abdominal distension, pressure, and fullness. In addition to relieving gas-related symptoms, simethicone is frequently used as an adjunct during gastrointestinal endoscopic procedures to improve mucosal visualization by reducing intraluminal foam. Because simethicone is not systemically absorbed and has a favorable safety profile, it is commonly used across diverse patient populations. This activity reviews the pharmacology, mechanism of action, clinical indications, dosage forms, dosing recommendations, adverse effects, contraindications, monitoring, toxicity, and available evidence supporting the use of simethicone. Participants enhance their ability to incorporate evidence-based recommendations into patient care, recognize safety considerations and potential interactions with concomitant medications, counsel patients on appropriate use, and collaborate effectively with pharmacists, nurses, and other healthcare professionals to optimize symptom management and therapeutic outcomes.

Background: Glucagon-like peptide-1 receptor agonists and dual glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 (GIP/GLP-1) receptor agonists have substantially improved the management of obesity and cardiometabolic disease, providing significant benefits on weight reduction, glycemic control, and cardiovascular outcomes. Despite these advances, gastrointestinal (GI) adverse events remain a major cause of dose reduction, treatment interruption, and poor long-term adherence. Increasing evidence suggests that interactions between incretin-based therapies and the intestinal microenvironment may contribute to GI tolerability and influence treatment persistence. Methods: We conducted a narrative review of the literature examining the relationship between incretin-based therapies, gut microbiota, intestinal barrier function, and microbial metabolites. Evidence from randomized clinical trials, observational studies, systematic reviews, and mechanistic investigations was evaluated to explore potential gut-directed supportive strategies during incretin-based treatment. Results: Preclinical and mechanistic evidence suggests possible bidirectional interactions between incretin pharmacology and the intestinal microenvironment, whereas direct human evidence remains limited and inconsistent. Alterations in gastrointestinal motility induced by GLP-1 receptor agonists could theoretically influence microbial composition and fermentation dynamics, although human studies have not consistently demonstrated significant microbiota changes. Based on these observations, we propose the Incretin-Microbiota Tolerance Axis (IMTA) as a conceptual framework linking gut homeostasis, GI tolerability, and treatment adherence. Among potential supportive interventions, partially hydrolyzed guar gum (PHGG) may promote SCFA-producing microbiota and improve bowel function, whereas simethicone may provide symptomatic relief of gas-related discomfort during dose escalation. SCFA-supportive nutritional approaches may further contribute to maintenance of intestinal homeostasis. Conclusions: Optimization of the intestinal microenvironment may represent a complementary strategy to improve GI tolerability and support long-term adherence during incretin-based therapy. Although the IMTA framework is supported by biological plausibility and emerging evidence, prospective clinical studies are required to determine whether microbiota-targeted interventions improve treatment persistence and cardiometabolic outcomes in patients receiving GLP-1 receptor agonists or dual GIP/GLP-1 receptor agonists.

Dyspeptic symptoms associated with chronic belching may substantially affect quality of life and can be challenging to manage in clinical practice. We report the case of a 40-year-old nulligravid woman with depressive disorder, bilateral cochlear implants due to deafness, a hiatal hernia, and a previous pulmonary embolism. Her medications included desvenlafaxine, multiple benzodiazepines, mirtazapine, trazodone, and apixaban. She presented with an 18-month history of persistent belching, heartburn, early satiety, and intermittent dry cough, severely impairing her quality of life and leading to social isolation. Additionally, her symptoms intensified during anxiety and depressive episodes. Physical examination was unremarkable, and upper gastrointestinal endoscopy revealed only a small hiatal hernia and mild gastropathy, with no evidence of Helicobacter pylori infection. Despite repeated medical evaluations and multiple therapeutic approaches, including proton pump inhibitors, sucralfate, domperidone, simethicone, and bilastine, symptoms persisted without significant improvement. Functional dyspepsia was therefore suspected, and treatment with baclofen 10 mg twice daily was initiated, resulting in significant clinical improvement and enhanced quality of life. This report highlights the potential benefit of baclofen in patients with persistent belching and dyspeptic symptoms refractory to conventional therapy, particularly in the context of psychiatric comorbidity.

Antispasmodics are commonly used to treat irritable bowel syndrome (IBS) symptoms. They are generally regarded as safe.However, some have been found to be ineffective or not cost-effective. Marked discrepancies in the availability and formulation of antispasmodic agents across countries—ranging from the limitation to only fundamental compounds in regions such as the United States to the marketing of diverse combination products elsewhere—have generated considerable ambiguity and debate within the field. Meta-analyses show varying results on the efficacy of antispasmodics, indicating the need for further analysis. This article aims to evaluate the effectiveness of antispasmodic drugs in relieving symptoms in IBS patients. We conclude that most drugs are considered safe and effective, with pinaverium, otilonium, and peppermint oil having meta-analyses supporting their efficacy. However, there is a lack of high-quality data for drugs like alverine, trimebutine, and cimetropium, and some drugs, such as simeticone or combinations of spasmolytic agents and simeticone, have insufficient research data. Clinicians should prioritize evidence-based medicine when selecting antispasmodic agents.

The US Multi-Society Task Force on Colorectal Cancer updated the 2014 consensus recommendations on colonoscopy preparation in 2025. For patients at low risk of inadequate preparation, key updates include simplifying dietary restrictions and using 2-L over 4-L regimens for improved tolerability while maintaining efficacy. Split-dose administration of bowel preparation is universally recommended. The guidelines emphasize same-day dosing as acceptable only for afternoon procedures, recommend oral simethicone as an adjunct for improved visualization, and establish preparation adequacy tracking as a quality metric.