Effect of gum chewing on ameliorating ileus following colorectal surgery: A meta-analysis of 18 randomized controlled trials

Liu, Qing; Jiang, Honglei; Xu, Dong; Jin, Junzhe

doi:10.1016/j.ijsu.2017.07.107

Cited by 60 publications

(46 citation statements)

References 35 publications

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“…[15] In the previous studies using chewing gum as a sham feeding, the case series of major abdominal surgery and colorectal resection have generally been employed. [13] It is clearly stated in the literature that these interventions are the most important factors of POI. [20] We think that studies conducted with the main factors in this multifactorial clinical condition will not provide healthy data.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple meta-analyses and reviews have published the positive effects of chewing gum on the intestinal motility as a sham feeding after abdominal surgery. [12][13] After recognizing the clinical benefits of chewing gum, it has been suggested that it will have a positive effect on the intestinal motility in two different pathways with the combination of nicotine. The first pathway has been hypothesized as the stimulation of cephalo-vagal reflex by chewing gum and the second pathway as the activation of cholinergic anti-inflammatory pathway by nicotine.…”

Section: Introductionmentioning

confidence: 99%

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An agent to improve gastrointestinal recovery after laparoscopy cholecystectomy: Nicotine gum

İşcan¹

2020

Laparosc Endosc Surg Sci

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Introduction: This study aims to investigate the gastrointestinal recovery effects of the nicotine gum after laparoscopic cholecystectomy. Materials and Methods: In this study, 119 patients were randomized into three groups as follows: Sugarfree gum, nicotine gum and control. After laparoscopic cholecystectomy, within an interval of two hours, the gum was chewed for 15 minutes by the gum groups. Demographic features, postoperative first flatus time, first hunger feelings, first defecation time, constipation scores, smoking, and drain usage were recorded. Results: The first flatus time of the Nicotine Gum group was significantly lower than those of the Control group (p=0.018). There was no statistically significant difference between the Sugar-Free Gum and the control group (p=0.992). The nicotine gum group was the first to have defecation in a significantly shorter period than the other two groups (p=0.036, p=0.008, p<0.05). According to smoking in all patients, the first flatus time was found to be significantly lower in smokers than in non-smokers (p=0.004). The findings showed that the time of the first defecation was statistically significantly earlier in the smoker patient group (p=0.015). Conclusion: Nicotine gum used as a sham feeding after laparoscopic cholecystectomy accelerated the recovery of the gastrointestinal system motility. Also, independently of sham feeding, the time of first postoperative gas and defecation were found to have occurred in the earlier period in the patient group of smokers.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An agent to improve gastrointestinal recovery after laparoscopy cholecystectomy: Nicotine gum

İşcan¹

2020

Laparosc Endosc Surg Sci

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“…Coffee has been shown to reduce time to first bowel movement after colorectal and gynecologic surgery by 9.4–15.4 h on average [ 17 , 23 , 24 ]. A recent meta-analysis on the effect of chewing gum on postoperative ileus after colorectal surgery, including 1736 patients from 18 RCTs, observed a reduction of 16.4 h (95% confidence interval: − 22.7; − 10.2) of time to first bowel movement [ 25 ]. One of the two studies in small bowel capsule endoscopy found a significant reduction of transit time.…”

Section: Discussionmentioning

confidence: 99%

Can coffee or chewing gum decrease transit times in Colon capsule endoscopy? A randomized controlled trial

et al. 2018

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BackgroundA high rate of complete colon capsule endoscopy (CCE) investigations is required for a more widespread use of CCE. The objective of this study was to assess if coffee or chewing gum can increase excretion of the colon capsule within battery life time (excretion rate).MethodsOne hundred eighty six screening participants with a positive immunochemical fecal occult blood test were included in this single-centre randomized controlled trial with blinding of the investigators to the randomization. Participants received instant coffee, chewing gum or nothing in addition to the standard bowel preparation.ResultsThe intention was to include 57 participants in the coffee group, 61 in the chewing gum group and 60 in the control group, on 8 participants data were missing. A total of 165 participants were included in a per protocol analysis. Exclusion was due to not receiving the allocated intervention (8 coffee, 4 chewing gum) and technical failure of the capsule (1 coffee). The excretion rate was 58% in the coffee group (n = 48), 63% in the chewing gum group (n = 57) and 55% in the control group (n = 60, p > 0.2). Transit times were similar in all groups. The excretion rate was low in participants who had transit times over 10 h (14%). A strong correlation was found between adequate cleansing and excretion of the capsule.There were no serious adverse events related to the interventions or CCE investigations.ConclusionsChewing gum and coffee did not improve excretion rate in this study. An effect of chewing gum could not be proven, possibly due to sample size. Since chewing gum might improve excretion rates, is cheap and has no known side effects, it needs to be considered in future bowel preparation trials for CCE.Trial registrationNCT02303756, registered on December 1st 2014.Electronic supplementary materialThe online version of this article (10.1186/s12876-018-0824-9) contains supplementary material, which is available to authorized users.

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“…It has been proposed that chewing gum may stimulate bowel motility -via vagal stimulation or gastrointestinal hormones secretion -with an earlier return of intestinal function and reduced LOS [100] , but unfortunately the vast majority of colorectal studies are small sized and of poor quality [101,102] . A large RCT on 402 patients clearly demonstrated that, although there is no detriment, there is no beneficial effect either [103] .…”

Section: Prevention Of Postoperative Ileusmentioning

confidence: 99%

Enhanced recovery after rectal surgery: what we have learned so far

Tebala¹,

Gordon–Dixon²,

Imtiaz³

et al. 2018

MIS

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Enhanced recovery after surgery (ERAS) protocols are gradually becoming the gold standard in the perioperative management of rectal patients. It is a multimodal and multidisciplinary approach that has the great merit to involve and empower the patient and bring him or her back to the centre of the strategy of care. If applied correctly, ERAS can improve the postoperative recovery, reduce the rate of complications and reduce the postoperative length of stay, in patients who had extensive pelvic dissection. The factors within ERAS and their application do not represent rigid schematizations but fluid concepts that may undergo substantial changes as soon as new evidence becomes available. The ERAS principles must be adapted to the specific environment and each team is expected to set up their own programme and quality control criteria. In this comprehensive review, the latest evidence and trend on enhanced recovery after rectal surgery have been critically appraised and presented.

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Effect of gum chewing on ameliorating ileus following colorectal surgery: A meta-analysis of 18 randomized controlled trials

Abstract: Based on current evidence, chewing gum offers an inexpensive, well-tolerated, safe and effective method to ameliorate ileus following colorectal surgery. However, tightly controlled, randomized and considerably larger multicenter trials are warranted to further validate our findings.

Cited by 60 publications

References 35 publications

An agent to improve gastrointestinal recovery after laparoscopy cholecystectomy: Nicotine gum

An agent to improve gastrointestinal recovery after laparoscopy cholecystectomy: Nicotine gum

Can coffee or chewing gum decrease transit times in Colon capsule endoscopy? A randomized controlled trial

Enhanced recovery after rectal surgery: what we have learned so far

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