title: Randomized clinical trial of postoperative chewing gum versus standard care after colorectal resection.
abstract: BACKGROUND
  Chewing gum may stimulate gastrointestinal motility, with beneficial effects on postoperative ileus suggested in small studies. The primary aim of this trial was to determine whether chewing gum reduces length of hospital stay (LOS) after colorectal resection. Secondary aims included examining bowel habit symptoms, complications and healthcare costs.
  
  
  METHODS
  This clinical trial allocated patients randomly to standard postoperative care with or without chewing gum (sugar-free gum for at least 10 min, four times per day on days 1-5) in five UK hospitals. The primary outcome was LOS. Cox regression was used to calculate hazard ratios for LOS.
  
  
  RESULTS
  Data from 402 of 412 patients, of whom 199 (49·5 per cent) were allocated to chewing gum, were available for analysis. Some 40 per cent of patients in both groups had laparoscopic surgery, and all study sites used enhanced recovery programmes. Median (i.q.r.) LOS was 7 (5-11) days in both groups (P = 0·962); the hazard ratio for use of gum was 0·94 (95 per cent c.i. 0·77 to 1·15; P = 0·557). Participants allocated to gum had worse quality of life, measured using the EuroQoL 5D-3L, than controls at 6 and 12 weeks after operation (but not on day 4). They also had more complications graded III or above according to the Dindo-Demartines-Clavien classification (16 versus 6 in the group that received standard care) and deaths (11 versus 0), but none was classed as related to gum. No other differences were observed.
  
  
  CONCLUSIONS
  Chewing gum did not alter the return of bowel function or LOS after colorectal resection.
  
  
  BACKGROUND
  ISRCTN55784442 (http://www.controlled-trials.com).
authors.affiliation: Schools of Oral and Dental Sciences, University of Bristol, Bristol, UK.|National Institute for Health Research Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol Education Centre, Bristol, UK.
authors.forename: C
authors.initials: C
authors.lastname: Atkinson
authors.affiliation: Schools of Oral and Dental Sciences, University of Bristol, Bristol, UK.|National Institute for Health Research Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol Education Centre, Bristol, UK.
authors.forename: C M
authors.initials: CM
authors.lastname: Penfold
authors.affiliation: Schools of Oral and Dental Sciences, University of Bristol, Bristol, UK.|National Institute for Health Research Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol Education Centre, Bristol, UK.
authors.forename: A R
authors.initials: AR
authors.lastname: Ness
authors.affiliation: Department of Coloproctology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Longman
authors.affiliation: Schools of Oral and Dental Sciences, University of Bristol, Bristol, UK.|National Institute for Health Research Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol Education Centre, Bristol, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Thomas
authors.affiliation: Schools of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: W
authors.initials: W
authors.lastname: Hollingworth
authors.affiliation: Schools of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: R
authors.initials: R
authors.lastname: Kandiyali
authors.affiliation: Schools of Oral and Dental Sciences, University of Bristol, Bristol, UK.|National Institute for Health Research Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol Education Centre, Bristol, UK.
authors.forename: S D
authors.initials: SD
authors.lastname: Leary
authors.affiliation: National Institute for Health Research Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol Education Centre, Bristol, UK.|Department of Gastroenterology, Derriford Hospital, Plymouth, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Lewis
mesh_terms: D000368:Aged; D002638:Chewing Gum; D003082:Colectomy; D003672:Defecation; D005260:Female; D005414:Flatulence; D005769:Gastrointestinal Motility; D006801:Humans; D045823:Ileus / Q000517:prevention & control*; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D011182:Postoperative Care; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D011788:Quality of Life; D016037:Single-Blind Method; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D002638:Chewing Gum