Medicine by the Numbers
A Collaboration of TheNNT.com and AFP
Chewing Gum for Reducing Post-Cesarean Section Ileus
Am Fam Physician. 2018 Sep 1;98(5):online.
Details for This Review
Study Population: More than 3,000 women (17 trials) who had just had cesarean section, mostly from the Middle East and Asia
Efficacy End Points: Primary: postoperative ileus, time to flatus; secondary: length of stay, time to defecation, need for enema, need for antiemetic, patient satisfaction
Harm End Points: Not assessed
Narrative: Postoperative ileus complicates a significant percentage of surgeries. By delaying the normal return to gastrointestinal function, postoperative ileus may increase patient discomfort and has been shown to prolong hospitalization by five days, increasing total costs by almost $1.5 billion annually in the United States.1 Surgeons and medical teams have tried numerous pharmacologic and nonpharmacologic interventions for postoperative ileus. The perfect intervention would be physiologic, effective, safe, and inexpensive. Early reintroduction of diet, although ideal, is not tolerated by some patients. Chewing gum may trigger salivation and the same neurodigestive processes that lead to normal gastrointestinal function and could represent a viable alternative to early diet reintroduction. Other research has shown gum chewing can reduce time to flatus, time to defecation, length of hospital stay, and the time to tolerate a diet in postoperative gynecologic oncology patients.2
Two studies examined the effectiveness of chewing gum to reduce post-cesarean section ileus.3,4 One review included 17 randomized controlled trials with more than 3,000 patients, and examined time to flatus and rate of ileus as primary outcomes.3 For time to flatus, they found 13 studies including 2,399 women. On average, chewing gum reduced this metric by seven hours. Regarding rate of ileus, four studies with 1,139 women demonstrated a reduction in incidence from 11% to 5%, yielding a number needed to treat (NNT) of 17. Secondary outcomes showed a reduction in time to defecation, as well as duration of hospital stay. The need for pain control or antiemetics did not differ between intervention and control groups.3
The other review focused on time to flatus as the primary outcome.4 Among 2,459 women, time to flatus was reduced from 29.5 to 23.1 hours. Secondary outcomes demonstrated reductions in rate
Referencesshow all references
1. Iyer S, Saunders WB, Sternkowski S. Economic burden of postoperative ileus associated with colectomy in the United States. J Manag Care Pharm. 2009;15(6):485–494....
2. Ertas IE, Gungorduk K, Ozdemir A, Solmas U, Dogan A, Yildirim Y. Influence of gum chewing on postoperative bowel activity after complete staging surgery for gynecological malignancies: a randomized controlled trial. Gynecol Oncol. 2013;131(1):118–122.
3. Pereira Gomes Morais E, Riera R, Porfírio GJ, et al. Chewing gum for enhancing early recovery of bowel function after caesarean section. Cochrane Database Syst Rev. 2016;(10):CD011562.
4. Ciardulli A, Saccone G, Di Mascio D, Caissutti C, Berghella V. Chewing gum improves postoperative recovery of gastrointestinal function after cesarean delivery: a systematic review and meta-analysis of randomized trials. J Matern Fetal Neonatal Med. 2018;31(14):1924–1932.
5. Craciunas L, Sajid MS, Ahmed AS. Chewing gum in preventing postoperative ileus in women undergoing caesarean section: a systematic review and meta-analysis of randomised controlled trials. BJOG. 2014;121(7):793–799.
6. Husslein H, Franz M, Gutschi M, Worda C, Polterauer S, Leipold H. Postoperative gum chewing after gynecologic laparoscopic surgery: a randomized controlled trial. Obstet Gynecol. 2013;122(1):85–90.
7. Zhu YP, Wang WJ, Zhang SL, Dai B, Ye DW. Effects of gum chewing on postoperative bowel motility after caesarean section: a meta-analysis of randomised controlled trials. BJOG. 2014;121(7):787–792.
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