Skip to main content
SpringerLink
Log in

Systematic Review and Meta-Analysis of Chewing-Gum Therapy in the Reduction of Postoperative Paralytic Ileus Following Gastrointestinal Surgery

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Postoperative ileus has long been considered an inevitable consequence of gastrointestinal surgery. It prolongs hospital stay, increases morbidity, and adds to treatment costs. Chewing is a form of sham feeding reported to stimulate bowel motility. This analysis examines the value of chewing-gum therapy in treatment of postoperative ileus.

Methods

A search for randomized, controlled trials studying elective gastrointestinal surgery was undertaken using MEDLINE, Embase, Cochrane Controlled Trials Register, and reference lists. Outcomes were extracted including time to first flatus and bowel motion, length of stay, and complications. Statistical analysis was undertaken using the weighted mean difference (WMD) and random-effects model with 95% confidence intervals (CI).

Results

Seven studies with 272 patients were included. For time to first flatus the analysis favored treatment with a WMD of 12.6 h (17%) reduction (95% CI −21.49 to −3.72; P = 0.005). For time to first bowel motion, treatment was favored with a WMD of 23.11 h (22%) reduction (95% CI −34.32 to −11.91; P < 0.001). For length of stay, the analysis showed a nonsignificant trend toward treatment with WMD of 23.88 h (12%) reduction (95% CI −53.29 to +5.53; P = 0.11). There were no significant differences in complication rates.

Conclusions

Chewing-gum therapy following open gastrointestinal surgery is beneficial in reducing the period of postoperative ileus, although without a significant reduction in length of hospital stay. These outcomes are not significant for laparoscopic gastrointestinal surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Delaney C (2005) Introduction, definitions, and clinical importance of postoperative ileus. Semin Colon Rectal Surg 16:182–183

    Article  Google Scholar 

  2. Salvador C, Sikirica M, Evans A et al (2005) Clinical and economic outcomes of prolonged postoperative ileus in patients undergoing hysterectomy and hemicolectomy. Pharm Ther (P&T) 30:590–595

    Google Scholar 

  3. Bosio R, Delaney C, Senagore A (2005) Economic impact of POI and prolonged length of stay. Semin Colon Rectal Surg 16:235–238

    Article  Google Scholar 

  4. Kehlet H, Williamson R, Buchler MW et al (2005) A survey of perceptions and attitudes among European surgeons towards the clinical impact and management of postoperative ileus. Colorectal Dis 73:245–250

    Article  Google Scholar 

  5. Kehlet H (2001) Review of postoperative ileus. Am J Surg 182(Suppl):3–10

    Article  Google Scholar 

  6. Luckey A, Livingston E, Tache Y (2003) Mechanisms and treatment of postoperative ileus. Arch Surg 138:206–214

    Article  PubMed  Google Scholar 

  7. Person B, Wexner S (2006) The management of postoperative ileus. Curr Probl Surg 43:12–65

    Article  Google Scholar 

  8. Carr CS, Ling KD, Boulos P et al (1996) Randomised trial of safety and efficacy of immediate postoperative enteral feeding in patients undergoing gastrointestinal resection. BMJ 312:869–871

    CAS  PubMed  Google Scholar 

  9. Lewis S, Egger M, Sylvester P et al (2001) Early enteral feeding versus “nil by mouth” after gastrointestinal surgery: systematic review and metaanalysis of controlled trials. BMJ 323:1–5

    Article  Google Scholar 

  10. Stewart BT, Woods RJ, Collopy BT et al (1998) Early feeding after elective open colorectal resections: a prospective randomized trial. Aust N Z J Surg 68:125–128

    Article  CAS  PubMed  Google Scholar 

  11. Chou S, Lin C, Hsieh H et al (2006) Gum chewing in patients with subtotal gastrectomy. Chir Gastroenterol 22:269–271

    Article  Google Scholar 

  12. Quah H, Samad A, Neathey A et al (2006) Gum chewing and postoperative ileus following open colectomy. Colorectal Dis 8:64–70

    Article  CAS  PubMed  Google Scholar 

  13. Matros E, Rocha F, Zinner M et al (2006) Does gum chewing ameliorate postoperative ileus? Results of a prospective, randomized, placebo-controlled trial. J Am Coll Surg 202:773–778

    Article  PubMed  Google Scholar 

  14. Schuster R, Grewal N, Greaney GC et al (2006) Gum chewing reduces ileus after elective open sigmoid colectomy. Arch Surg 141:174–176

    Article  PubMed  Google Scholar 

  15. Hirayama I, Suzuki M, Ide M et al (2006) Gum-chewing stimulates bowel motility after surgery for colorectal cancer. Hepatogastroenterology 53:206–208

    PubMed  Google Scholar 

  16. Schluender S, Gurland B, Divino C et al (2005) Gum chewing does not enhance the return of bowel function in patients undergoing elective colon resection in a randomized blinded pilot study. Colorectal Dis 92(Suppl 1):P143

    Google Scholar 

  17. McCormick J, Garvin R, Caushaj P et al (2005) The effects of gum-chewing on bowel function and hospital stay after laparoscopic vs open colectomy: a multi-institution prospective randomized trial. J Am Coll Surg 201(Suppl 1):66–67

    Article  Google Scholar 

  18. Asao T, Kuwano H, Nakamura J et al (2002) Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy. J Am Coll Surg 195:30–32

    Article  PubMed  Google Scholar 

  19. Moher D, Cook DJ, Eastwood S et al (1999) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement—quality of reporting of meta-analyses. Lancet 354:1896–1900

    Article  CAS  PubMed  Google Scholar 

  20. Higgins J, Green S (2006) Cochrane handbook for systematic reviews of intervention, version 4.2.6, 4th edn. Cochrane Collaboration Secretariat, Oxford, UK

    Google Scholar 

  21. Jadad AR, Moore RA, Carroll D et al (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clin Trials 17:1–12

    Article  CAS  PubMed  Google Scholar 

  22. Kouba EJ, Wallen EM, Pruthi RS (2007) Gum chewing stimulates bowel motility in patients undergoing radical cystectomy with urinary diversion. Urology 70:1053–1056

    Article  PubMed  Google Scholar 

  23. Zhang Q, Zhao P (2008) Influence of gum chewing on return of gastrointestinal function after gastric abdominal surgery in children. Eur J Pediatr Surg 18:44–46

    Article  PubMed  Google Scholar 

  24. Chan MK, Law WL (2007) Use of chewing gum in reducing postoperative ileus after elective colorectal resection: a systematic review. Dis Colon Rectum 50:2149–2157

    Article  PubMed  Google Scholar 

  25. De Castro SM, van den Esschert JW, van Heek NT et al (2008) A systematic review of the efficacy of gum chewing for the amelioration of postoperative ileus. Dig Surg 25:39–45

    Article  PubMed  Google Scholar 

  26. Senagore AJ (2007) Pathogenesis and clinical and economic consequences of postoperative ileus. Am J Health Syst Pharm 64(Suppl 13):S3–S7

    Article  PubMed  Google Scholar 

  27. Fukuda H, Tsuchida D, Koda K et al (2007) Inhibition of sympathetic pathways restores postoperative ileus in the upper and lower gastrointestinal tract. J Gastroenterol Hepatol 22:1293–1299

    Article  PubMed  Google Scholar 

  28. Luckey A, Wang L, Jamieson PM et al (2003) Corticotropin-releasing factor receptor 1-deficient mice do not develop postoperative gastric ileus. Gastroenterology 125:654–659

    Article  CAS  PubMed  Google Scholar 

  29. The FO, Boeckxstaens GE, Snoek SA et al (2007) Activation of the cholinergic anti-inflammatory pathway ameliorates postoperative ileus in mice. Gastroenterology 133:1219–1228

    Article  CAS  PubMed  Google Scholar 

  30. Traut U, Brugger L, Kunz R et al (2008) Systemic prokinetic pharmacologic treatment for postoperative adynamic ileus following abdominal surgery in adults. Cochrane Database Syst Rev (Online) 1:CD004930

    Google Scholar 

  31. Kraft MD (2007) Emerging pharmacologic options for treating postoperative ileus. Am J Health Syst Pharm 64(Suppl 13):S13–S20

    Article  CAS  PubMed  Google Scholar 

  32. Yuan CS, Wei G, Foss JF et al (2002) Effects of subcutaneous methylnaltrexone on morphine-induced peripherally mediated side effects: a double-blind randomized placebo-controlled trial. J Pharmacol Exp Ther 300:118–123

    Article  CAS  PubMed  Google Scholar 

  33. Yuan CS, Foss JF (2000) Oral methylnaltrexone for opioid-induced constipation. JAMA 284:1383–1384

    Article  CAS  PubMed  Google Scholar 

  34. Delaney CP, Wolff BG, Viscusi ER et al (2007) Alvimopan, for postoperative ileus following bowel resection: a pooled analysis of Phase III studies. Ann Surg 245:355–363

    Article  PubMed  Google Scholar 

  35. Reisine T, Pasternak G (1996) Opioid analgesics and antagonists. In: Hardman J, Limbird L (eds) Goodman & Gilman’s the pharmacological basis of therapeutics. McGraw-Hill, New York

    Google Scholar 

  36. Carli F, Trudel JL, Belliveau P (2001) The effect of intraoperative thoracic epidural anesthesia and postoperative analgesia on bowel function after colorectal surgery: a prospective, randomized trial. Dis Colon Rectum 44:1083–1089

    Article  CAS  PubMed  Google Scholar 

  37. Miedema BW (2002) Postoperative ileus after laparoscopic colectomy. J Am Coll Surg 195:901 (Author reply 901–902)

    Article  PubMed  Google Scholar 

  38. Chen HH, Wexner SD, Iroatulam AJ et al (2000) Laparoscopic colectomy compares favorably with colectomy by laparotomy for reduction of postoperative ileus. Dis Colon Rectum 43:61–65

    Article  CAS  PubMed  Google Scholar 

  39. Lacy AM, Garcia-Valdecasas JC, Delgado S et al (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229

    Article  PubMed  Google Scholar 

  40. Delaney CP, Kiran RP, Senagore AJ et al (2003) Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery. Ann Surg 238:67–72

    Article  PubMed  Google Scholar 

  41. Stern RM, Crawford HE, Stewart WR et al (1989) Sham feeding: cephalic-vagal influences on gastric myoelectric activity. Dig Dis Sci 34:521–527

    Article  CAS  PubMed  Google Scholar 

  42. Waldhausen JH, Shaffrey ME, Skenderis BSII et al (1990) Gastrointestinal myoelectric and clinical patterns of recovery after laparotomy. Ann Surg 211:777–784 (discussion 785)

    Article  CAS  PubMed  Google Scholar 

  43. Tandeter H (2009) Hypothesis: hexitols in chewing gum may play a role in reducing postoperative ileus. Med Hypotheses 72:39–40

    Article  CAS  PubMed  Google Scholar 

  44. Tasaka A, Tahara Y, Sugiyama T et al (2008) Influence of chewing rate on salivary stress hormone levels. Nihon Hotetsu Shika Gakkai Zasshi 52:482–487

    Article  PubMed  Google Scholar 

  45. Scholey A, Haskell C, Robertson B et al (2009) Chewing gum alleviates negative mood and reduces cortisol during acute laboratory psychological stress. Physiol Behav 97:304–312

    Article  CAS  PubMed  Google Scholar 

  46. Apostolopoulos P, Kalantzis C, Gralnek IM et al (2008) Clinical trial: effectiveness of chewing-gum in accelerating capsule endoscopy transit time—a prospective randomized, controlled pilot study. Aliment Pharmacol Ther 28:405–411

    Article  CAS  PubMed  Google Scholar 

  47. Hetherington M, Boyland E (2007) Short-term effects of chewing gum on snack intake and appetite. Appetite 48:397–401

    Article  PubMed  Google Scholar 

  48. Milov D, Andres J, Erhart N et al (1998) Chewing gum bezoars of the gastrointestinal tract. Pediatrics 102:e22

    Article  CAS  PubMed  Google Scholar 

  49. Njau S (2003) Adult sudden death caused by aspiration of chewing gum. Forensic Sci Int 139:103–106

    Article  Google Scholar 

  50. Thompson A, Razak S, Jayasinghe R (2007) Cardiac arrest and chewing gum: an unfortunate combination. Med J Aust 187:635

    PubMed  Google Scholar 

  51. Blumenthal H, Vance D (1997) Chewing gum headaches. Headache 37:665–666

    Article  CAS  PubMed  Google Scholar 

  52. Moneret-Vautrin D, Faure G, Bene M (1986) Chewing-gum preservative induced toxidermic vasculitis. Allergy 41:546–548

    Article  CAS  PubMed  Google Scholar 

  53. Bauditz J, Norman K, Biering H et al (2008) Severe weight loss caused by chewing gum. BMJ 336:96–97

    Article  PubMed  Google Scholar 

  54. Moher D, Schulz KF, Altman DG (2001) The CONSORT statement: revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet 357:1191–1194

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. J. Edward F. Fitzgerald

    Present address: Medical Education Unit, University of Nottingham Medical School, Queens Medical Centre, Derby Road, Nottingham, NG7 2UH, UK

Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK

    J. Edward F. Fitzgerald

  2. Department of Surgery, Aberdeen Royal Infirmary, Aberdeen, AB25 2ZA, Scotland

    Irfan Ahmed

Authors
  1. J. Edward F. Fitzgerald
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Irfan Ahmed
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Edward F. Fitzgerald.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 32 kb)

Supplementary material 2 (DOC 41 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fitzgerald, J.E.F., Ahmed, I. Systematic Review and Meta-Analysis of Chewing-Gum Therapy in the Reduction of Postoperative Paralytic Ileus Following Gastrointestinal Surgery. World J Surg 33, 2557–2566 (2009). https://doi.org/10.1007/s00268-009-0104-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-009-0104-5

Keywords

Search

Navigation