Cochrane for Clinicians

Putting Evidence into Practice

Chewing Gum for Postoperative Recovery of Gastrointestinal Function


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Am Fam Physician. 2015 Dec 1;92(11):974-975.

Author disclosure: No relevant financial affiliations.

Clinical Question

Does chewing gum reduce the risk of ileus by speeding the return of flatus and bowel movements in the postoperative setting?

Evidence-Based Answer

Having patients chew gum reduces the time to first flatus and time to first bowel movement, as well as the length of hospitalization by about half a day. (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)

Practice Pointers

Postoperative ileus is common and may lead to prolonged hospitalization among other complications. Enhanced Recovery After Surgery techniques, including optimal pain control by epidural and local anesthesia, minimally invasive techniques, and aggressive postoperative rehabilitation, have been shown to reduce the risk of ileus.1 However, early postoperative feeding, one aspect of the Enhanced Recovery After Surgery program, may increase the risk of vomiting. Having patients chew gum in the postoperative period is not an aspect of the program, but it may decrease the risk of ileus by stimulating the cephalovagal system and intestinal motility while encouraging the

Author disclosure: No relevant financial affiliations.

The practice recommendations in this activity are available at


Short V, Herbert G, Perry R, et al. Chewing gum for postoperative recovery of gastrointestinal function. Cochrane Database Syst Rev. 2015;(2):CD006506.


1. Spanjersberg WR, Reurings J, Keus F, van Laarhoven CJ. Fast track surgery versus conventional recovery strategies for colorectal surgery. Cochrane Database Syst Rev. 2011;(2):CD007635.

2. National Institute for Health and Care Excellence (NICE). Caesarean section. London, United Kingdom: NICE; 2011. Accessed October 13, 2015.

3. Perioperative care of the pregnant woman. Evidence-based clinical practice guideline. Washington, DC: Association of Women's Health, Obstetric and Neonatal Nurses; 2011. Accessed October 13, 2015.

These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.

A collection of Cochrane for Clinicians published in AFP is available at


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