title: A prospective randomized controlled trial of sugared chewing gum on gastrointestinal recovery after major colorectal surgery in patients managed with early enteral feeding.
abstract: BACKGROUND
  A number of small prospective studies with conflicting results have evaluated the effect of sugar-free chewing gum on postoperative GI recovery in patients initially maintained nil per os after major colorectal surgery.
  
  
  OBJECTIVE
  We sought to evaluate the effect of sugared chewing gum in combination with early enteral feeding on recovery of GI function after major colorectal surgery to ascertain any additive effects of this combination.
  
  
  METHODS
  This was a randomized prospective study.
  
  
  METHODS
  This study was conducted at a single-institution tertiary referral center.
  
  
  METHODS
  Patients undergoing major colorectal surgery were included.
  
  
  METHODS
  Patients were randomly assigned to sugared chewing gum (Gum) (instructed to chew 3 times daily; 45 minutes each time for 7 days postoperatively) or No Gum after major colorectal surgery.
  
  
  METHODS
  The primary outcome measured was time to tolerating low residue diet without emesis for 24 hours. The secondary outcomes measured were time to flatus, time to bowel movement, postoperative hospital stay, postoperative pain, nausea, and appetite.
  
  
  RESULTS
  One hundred fourteen patients (60 No Gum; 54 Gum) were included in our analysis after randomization. There was no significant difference in time to tolerating a low-residue diet, time to flatus, time to bowel movement, length of postoperative hospital stay, postoperative complications, postoperative pain, nausea, or appetite between patients assigned to Gum or No Gum. There was an increased incidence of bloating, indigestion, and eructation in the Gum group (13%) in comparison with the No Gum group (2%) (p = 0.03).
  
  
  CONCLUSIONS
  Study subjects and investigators were not blinded. Multiple types of operations may cause intergroup variability.
  
  
  CONCLUSIONS
  There does not appear to be any benefit to sugared chewing gum in comparison with no gum in patients undergoing major colorectal surgery managed with early feeding in the postoperative period. There may be increased incidence of bloating, indigestion, and eructation, possibly related to swallowed air during gum chewing.
authors: From the Division of Colorectal Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA.
authors: Karen
authors: K
authors: Zaghiyan
authors: Seth
authors: S
authors: Felder
authors: Gayane
authors: G
authors: Ovsepyan
authors: Zuri
authors: Z
authors: Murrell
authors: Thomas
authors: T
authors: Sokol
authors: Beth
authors: B
authors: Moore
authors: Phillip
authors: P
authors: Fleshner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002638:Chewing Gum; D003107:Colorectal Surgery / Q000009:adverse effects*; D003672:Defecation; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005769:Gastrointestinal Motility / Q000187:drug effects*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy* / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002638:Chewing Gum