Colorectal surgery chewing gum benefits come unstuck
By Kirsty Oswald, medwireNews Reporter
14 March 2013
Dis Col Rectum 2013; 56: 328–335

medwireNews: Sugared chewing gum does not help improve postoperative recovery in patients undergoing colorectal surgery, study results show.

It has previously been suggested that sugar-free gum could be used to aid gastrointestinal recovery after surgery and prevent ileus - a major cause of delayed hospital discharge.

However, findings published in Diseases of the Colon and Rectum showed that not only did sugared gum fail to do this, it led to an increase in undesirable gastric symptoms such as bloating and indigestion compared with no gum chewing.

In the study of 114 patients undergoing open and laparoscopic major colorectal surgery, there was no significant difference in time to tolerating a low residue diet between patients who chewed sugared gum three times a day for 45 minutes on days 1-7 after surgery (n=54) and those who did not (mean: 56.1 vs 54.1 hours).

There was also no difference in time to first flatus, time to first bowel movement, or postoperative length of stay, and a similar number of patients in each group experienced postoperative ileus (four patients in each group), report Phillip Fleshner (Cedars Sinai Medical Center, Los Angeles, California, USA) and colleagues.

And, while there was no difference in reporting of daily nausea, pain, or appetite scores between the groups, patients in the chewing gum group had a significantly higher incidence of hiccups, eructation, or indigestion, compared with the no gum group (13 vs 2%).

Previous studies of post-colorectal surgery chewing gum have been small and produced conflicting results, say Fleshner and colleagues. They may have been conflicted by the effects of sugar substitutes with laxative effects, the authors add.

"The mechanism to explain any potential stimulated GI [gastrointestinal] motility via gum chewing has yet to be fully understood and may not be related to the presumed cephalic-vagal reflex, but rather to the motility effects of hexitols in sugar-free gum," say the researchers, who believe air swallowing while chewing may explain the adverse effects observed.

"A future study correlating the levels of gastric peptides and catecholamines with postoperative ileus following colorectal surgery in patients who chew sugared and sugar-free gum may better help elucidate these unanswered observations," they suggest.

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