Effects of Gum Chewing on Recovery From Postoperative Ileus: A Randomized Clinical Trail

10.1097/jnr.0000000000000510

Ya-Chuan HSU；Shu-Ying SZU

postsurgical ileus ； sham feeding ； chewing gum ； colorectal cancer ； bowel movement

The Journal of Nursing Research

30卷5期（2022 / 10 / 01）

1 - 9

英文

Background: Sham feeding with products such as chewing gum has been theorized to decrease the incidence and time to resolution of postoperative ileus. The conflicting findings in the literature on this subject are because in part of the use of mixed study populations, which has led to difficulties in assessing the value of sham feeding in ameliorating this condition. Purpose: The aim of this study was to evaluate the efficacy of postsurgical gum chewing in restoring normal bowel movement in patients with colorectal cancer who had undergone abdominal surgery for colon resection. Methods: A randomized controlled trial was used to examine the time to first postoperative flatus and defecation. The intervention group (n = 30) received xylitol chewing gum on the first day after colon resection, one piece of gum for 15 minutes, 3 times daily, until the time to first flatus and defecation. Both the intervention and control groups (n = 30) received standard postoperative care and were encouraged to walk as soon as possible after surgery. The time to first flatus was reported by patients. Results: The time to first flatus and defecation in the intervention group was significantly shorter than that in the control group (39.13 ± 15.66 vs. 52.92 ± 21.97 hours and 54.55 ± 18.90 vs. 77.98 ± 34.59 hours, respectively). However, after controlling for age and surgical duration, only time to first flatus was significantly shorter in the intervention group. Significantly positive correlations were found between time to first flatus and time to first defecation in both groups. Conclusions/Implications for Practice: In this study, gum chewing was shown to have a positive effect on the time to first postoperative flatus and defecation. This inexpensive and noninvasive intervention may be recommended to decrease the time to resolution of postsurgical ileus in middle-aged and older patients who have undergone open abdominal surgery for colorectal resection.

1. Altraigey, A.,Ellaithy, M.,Atia, H.,Abderlrehim, W.,Abbas, A. M.,Asiri, M.(2020).The effect of gum chewing on the return of bowel motility after planned cesarean delivery: A randomized controlled trial.The Journal of Maternal-Fetal & Neonatal Medicine,33(10),1670-1677.
2. Bauer, A. J.,Boeckxstaens, G. E.(2004).Mechanisms of postoperative ileus.Neurogastroenterology and Motility,16(2, Suppl.),54-60.
3. Bauer, A. J.,Sarr, M. G.,Szurszewski, J. H.(1991).Opioids inhibit neuromuscular transmission in circular muscle of human and baboon jejunum.Gastroenterology,101(4),970-976.
4. Behm, B.,Stollman, N.(2003).Postoperative ileus: Etiologies and interventions.Clinical Gastroenterology and Hepatology,1(2),71-80.
5. Ceretti, A. P.,Maroni, N.,Longhi, M.,Giovenzana, M.,Santambrogio, R.,Barabino, M.,Luigiano, C.,Radaelli, G.,Opocher, E.(2018).Risk factors for prolonged postoperative ileus in adult patients undergoing elective colorectal surgery: An observational cohort study.Reviews on Recent Clinical Trials,13(4),295-304.
6. Chapman, S. J.,Pericleous, A.,Downey, C.,Jayne, D. G.(2018).Postoperative ileus following major colorectal surgery.British Journal of Surgery,105(7),797-810.
7. Chen, H. H.,Wexner, S. D.,Iroatulam, A. J.,Pikarsky, A. J.,Alabaz, O.,Nogueras, J. J.,Nessim, A.,Weiss, E. G.(2000).Laparoscopic colectomy compares favorably with colectomy by laparotomy for reduction of postoperative ileus.Diseases of the Colon and Rectum,43(1),61-65.
8. Choi, H.,Kang, S. H.,Yoon, D. K.,Kang, S. G.,Ko, H. Y.,Moon, Du G.,Park, J. Y.,Joo, K. J.,Cheon, J.(2011).Chewing gum has a stimulatory effect on bowel motility in patients after open or robotic radical cystectomy for bladder cancer: A prospective randomized comparative study.Urology,77(4),884-890.
9. Crooks, V.,Waller, S.,Smith, T.,Hahn, T. J.(1991).The use of the Karnofsky Performance Scale in determining outcomes and risk in geriatric outpatients.Journal of Gerontology,46(4),M139-M144.
10. de Leede, E. M.,van Leersum, N. J.,Kroon, H. M.,van Weel, V.,van der Sijp, J.,Bonsing, B. A.,Woltz, S.,Tromp, M.,Neijenhuis, P. A.,Maaijen, R. C. L. A.,Steup, W. H.,Schepers, A.,Guicherit, O. R.,Huurman, V. A. L.,Karsten, T. M.,van de Pool, A.,Boerma, D.,Deroose, J. P.,Beek, M.,Kauwgomstudie Consortium(2018).Multicentre randomized clinical trial of the effect of chewing gum after abdominal surgery.The British Journal of Surgery,105(7),820-828.
11. Faul, F.,Erdfelder, E.,Buchner, A.,Lang, A.-G.(2009).Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses.Behavior Research Methods,41,1149-1160.
12. Fesharakizadeh, M.,Taheri, D.,Dolatkhah, S.,Wexner, S. D.(2013).Postoperative ileus in colorectal surgery: Is there any difference between laparoscopic and open surgery?.Gastroenterology Report,1(2),138-143.
13. Forrester, D. A.,Doyle-Munoz, J.,McTigue, T.,D'Andrea, S.,Natale-Ryan, A.(2014).The efficacy of gum chewing in reducing postoperative ileus: A multisite randomized controlled trial.Journal of Wound, Ostomy, and Continence Nursing,41(3),227-232.
14. Gustafsson, U. O.,Scott, M. J.,Hubner, M.,Nygren, J.,Demartines, N.,Francis, N.,Rockall, T. A.,Young-Fadok, T. M.,Hill, A. G.,Soop, M.,de Boer, H. D.,Urman, R. D.,Chang, G. J.,Fichera, A.,Kessler, H.,Grass, F.,Whang, E. E.,Fawcett, W. J.,Carli, F.,Ljungqvist, O.(2019).Guidelines for perioperative care in elective colorectal surgery: Enhanced Recovery After Surgery (ERAS®) society recommendations: 2018.World Journal of Surgery,43(3),659-695.
15. Harnsberger, C. R.,Maykel, J. A.,Alavi, K.(2019).Postoperative ileus.Clinics in Colon and Rectal Surgery,32(3),166-170.
16. Ho, Y. M.,Smith, S. R.,Pockney, P.,Lim, P.,Attia, J.(2014).A meta-analysis on the effect of sham feeding following colectomy should gum chewing be included in enhanced recovery after surgery protocols.Diseases of the Colon and Rectum,57(1),115-126.
17. Kasparek, M. S.,Müller, M. H.,Glatzle, J.,Manncke, K.,Becker, H. D.,Zittel, T. T.,Kreis, M. E.(2003).Postoperative colonic motility in patients following laparoscopic-assisted and open sigmoid colectomy.Journal of Gastrointestinal Surgery,7(8),1073-1081.
18. Kobayashi, T.,Masaki, T.,Kogawa, K.,Matsuoka, H.,Sugiyama, M.(2015).Efficacy of gum chewing on bowel movement after open colectomy for left-sided colorectal cancer: A randomized clinical trial.Diseases of the Colon and Rectum,58(11),1058-1063.
19. Lee, J. T.,Hsieh, M. H.,Cheng, P. J.,Lin, J. R.(2018).The role of xylitol gum chewing in restoring postoperative bowel activity after cesarean section.Biological Research in Nursing,18(2),167-172.
20. Lei, W. Z.,Zhao, G. P.,Cheng, Z.,Li, K.,Zhou, Z. G.(2004).Gastrointestinal decompression after excision and anastomosis of lower digestive tract.World Journal of Gastroenterology,10(13),1998-2001.
21. Li, S.,Liu, Y.,Peng, Q.,Xie, L.,Wang, J.,Qin, X.(2013).Chewing gum reduces postoperative ileus following abdominal surgery: A meta-analysis of 17 randomized controlled trials.Journal of Gastroenterology and Hepatology,28(7),1122-1132.
22. Liu, Q.,Jiang, H.,Xu, D.,Jin, J.(2017).Effect of gum chewing on ameliorating ileus following colorectal surgery: A meta-analysis of 18 randomized controlled trials.International Journal of Surgery,47,107-115.
23. Livingston, E. H.,Passaro, E. P.(1990).Postoperative ileus.Digestive Diseases and Sciences,35(1),121-132.
24. Nelson, R. L.,Edwards, S.,Tse, B.(2007).Prophylactic nasogastric decompression after abdominal surgery.Cochrane Database of Systematic Reviews,2007(3),Article ID CD004929.
25. Ohta, M.,Ueda, T.,Sakurai, K.(2017).Effect of chewing or compressing food on autonomic nervous activity in older adults.Gerodontology,34(4),434-440.
26. Pisarska, M.,Pędziwiatr, M.,Małczak, P.,Major, P.,Ochenduszko, S.,Zub-Pokrowiecka, A.,Kulawik, J.,Budzyński, A.(2016).Do we really need the full compliance with ERAS protocol in laparoscopic colorectal surgery? A prospective cohort study.International Journal of Surgery,36(Pt. A),377-382.
27. Procacciante, F.,De Luca, M.,Abilaliaj, V.,Chiaretti, M.,Diamantini, G.(2013).Post-operative ileus in hemicolectomy for cancer: Open versus laparoscopic approach.Annali Italiani di Chirurgia,84(5),557-562.
28. Sapci, I.,Hameed, I.,Ceylan, A.,Oktem, A.,Rencuzogullari, A.,Hull, T. L.,Liska, D.,Delaney, C. P.,Gorgun, E.(2020).Predictors of ileus following colorectal resections.American Journal of Surgery,219(3),527-529.
29. Schuster, R.,Grewal, N.,Greaney, G. C.,Waxman, K.(2006).Gum chewing reduces ileus after elective open sigmoid colectomy.Archives of Surgery,141(2),174-176.
30. Spencer, N. J.,Dinning, P. G.,Brookes, S. J.,Costa, M.(2016).Insights into the mechanisms underlying colonic motor patterns.The Journal of Physiology,594(15),4099-4116.
31. van den Heijkant, T. C.,Costes, L. M.,van der Lee, D. G.,Aerts, B.,Osinga-de Jong, M.,Rutten, H. R.,Hulsewé, K. W.,de Jonge, W. J.,Buurman, W. A.,Luyer, M. D.(2015).Randomized clinical trial of the effect of gum chewing on postoperative ileus and inflammation in colorectal surgery.The British Journal of Surgery,102(3),202-211.
32. Vather, R.,Trivedi, S.,Bissett, I.(2013).Defining postoperative ileus: Results of a systematic review and global survey.Journal of Gastrointestinal Surgery,17(5),962-972.
33. Venara、 A.,Alfonsi, P.,Cotte, E.,Loriau, J.,Hamel, J.-F.,Slim, K.,Francophone Group for Enhanced Recovery After Surgery(2019).Postoperative ileus concealing intra-abdominal complications in enhanced recovery programs-A retrospective analysis of the GRACE database.International Journal of Colorectal Disease,34,71-83.
34. Venara, A.,Hamel, J.-F.,Cotte, E.,Meillat, H.,Sage, P.-Y.,Slim, K.,GRACE Group(2020).Intraoperative nasogastric tube during colorectal surgery may not be mandatory: A propensity score analysis of a prospective database.Surgical Endoscopy,34(12),5583-5592.
35. Walker, J.,Hosiner, A.,Kergoat, S.,Walker, J. M.,Somoza, V.(2016).Chewing unflavored gum does not reduce cortisol levels during a cognitive task but increases the response of the sympathetic nervous system.Physiology & Behavior,154,8-14.
36. Yang, P.,Long, W. J.,Wei, L.(2018).Chewing xylitol gum could accelerate bowel motility recovery after elective open proctectomy for rectal cancer.Revista de Investigacion Clinica; Organo del Hospital de Enfermedades de la Nutricion,70(1),53-58.