A meta-analysis published in the August issue of Archives of Surgery concludes that patients who have surgery to remove all or part of the colon (colectomy) have enhanced recovery of intestinal function if they chew gum.
“Postoperative ileus [inability of the intestines to pass contents] is regarded as an inevitable response to the trauma of abdominal surgery and is a major contributing factor to postoperative pain and discomfort associated with abdominal distension, nausea, vomiting and cramping pain,” write Sanjay Purkayastha, B.Sc., M.R.C.S. (St. Mary’s Hospital, London) and colleagues. In the United States, this problem is estimated to cost about $1 billion in health care expenditures.
The researchers undertook an analysis of data from 158 patients in five trials that were published on or before July 2006. The trials were similarly designed such that after surgery, one group of patients chewed sugarless gum three times per day for a period of five to 45 minutes and a second group did not chew gum.
Aggregation of the results found positive signs of returning intestinal function for those who chewed gum: chewers took an average of .66 fewer days to pass flatus (gas) and an average of 1.10 fewer days to have a bowel movement. “Postoperative length of hospital stay was assessed in four trials comprising 134 patients,” add the authors. “This was also reduced in the chewing gum group by longer than one day; however, this result was not statistically significant.”
The explanation of gum chewing’s effectiveness begins with its stimulating nerves in the digestive system, a kind of “sham feeding” that triggers the release of gastrointestinal hormones and increases the production of saliva and secretions from the pancreas.
“We feel that the current evidence suggests that gum chewing following abdominal surgery offers significant benefits in reducing the time to resolution of ileus; however, the studies are insufficiently powered to identify a significant benefit in length of stay,” the researchers conclude. “The potential benefits to individual patients, in health economics terms, are such that a well-designed, large-scale, blinded, randomized, controlled trial with a placebo arm is warranted to answer the question of whether gum chewing can significantly reduce the length of stay after abdominal surgery or whether it merely represents a placebo effect.”
Meta-analysis of Randomized Studies Evaluating Chewing Gum to Enhance Postoperative Recovery Following Colectomy
Sanjay Purkayastha; Henry S. Tilney; Ara W. Darzi; Paris P. Tekkis
Archives of Surgery (2008). 143:788-793.
Written by: Peter M Crosta