Use of air in double contrast barium enema--is it still acceptable?

There is conflicting evidence regarding the benefit of using carbon dioxide in a double contrast barium enema. In a double blind prospective study, 200 patients undergoing out-patient double contrast barium enemas (DCBE) were randomly allocated to receive either air or carbon dioxide (CO2) insufflation. After 24 h they were requested to complete and return a questionnaire regarding abdominal pain and distension experienced following the examination. The use of CO2 reduced the incidence of severe post-DCBE pain from 27% to 7%. There was a higher incidence of severe pain in younger patients, regardless of which gas was used. The incidence of severe pain following DCBE was unrelated to the presence or absence of abdominal pain as part of the patient's symptomatology. In the light of these findings we advocate the routine use of CO2 in DCBE.