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.

image

 Enlarge     Print

CHEWING GUM FOR REDUCING POST-CESAREAN SECTION ILEUS

BenefitsHarms

1 in 14 to 17 had decreased postoperative ileus

Not assessed

CHEWING GUM FOR REDUCING POST-CESAREAN SECTION ILEUS

BenefitsHarms

1 in 14 to 17 had decreased postoperative ileus

Not assessed

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

Author disclosure: No relevant financial affiliations.

References

show 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.

 

 

Copyright © 2018 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in Pubmed

MOST RECENT ISSUE


Sep 15, 2018

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article