Gum chewing is a safe and simple treatment to reduce postoperative ileum (POI), and is associated with a reduction in systemic inflammatory markers and complications.

1. Dr Arjun Rajagopalan
BIOPSYBIOPSY

2. Dr Arjun Rajagopalan
BIOPSY We know …
• Postoperative ileus (POI) has an impact on
patient comfort, recovery and morbidity.
• An inflammatory response to intestinal
handling is postulated as the mechanism of
production of POI.
• Activation of the autonomic nervous system
is a means of reducing POI.
We don’t know …
• Gum chewing might mitigate POI by its
effect on the vagus. Is this a clinically useful
tool for shortening POI?

3. Dr Arjun Rajagopalan
BIOPSY 1: Population
Adults undergoing
elective, open,
colorectal surgery
Chewing gum started
3 hours before surgery
and resumed 3 hours
after recovery.
Frequency and
duration ad lib.
Distribution
60 52 Chewing gum
Placebo
Dermal patch
containing a
placebo

4. Dr Arjun Rajagopalan
BIOPSY
3: Outcome
variable
2: Indicator
variable
4: Comparison
POI
Flatus within 48 h
Stool within 4 days
Grade IIIB complications *
3%
65%
85%
27%
16%
50%
57%
48%
Placebo
Chewing gum
Outcomes Placebo (60) Chewing gum (52) p’
Length of stay (days) 14.0 9.5 NS
Antral size reduction (US) 10% 25% 0.004
IL-8 (pg/ ml) 288 133 0.045
TNF-A (ng/ ml) 0.92 0.74 0.043
* - complication requiring intervention under anaesthesia
p = 0.044
p = 0.006
p = 0.031
p = 0.02

5. Dr Arjun Rajagopalan
BIOPSY The author(s) conclude …
Gum chewing is a safe and simple treatment to
reduce postoperative ileus (POI), and is
associated with a reduction in systemic
inflammatory markers and complications.
METHODOLOGY
Type of study Interventional
SAMPLING
Centre Teaching hospital, Netherlands
TIme frame May 2009 - Sep 2012
Analysis Prospective RCT
A priori sample
size calculation
120 patients
Exclusions
Peritoneal carcinomatosis,
IBD, Previous stomach or
oesophageal surgery, stoma,
using agents that influence gut
motility, mint allergy
Numbers
120 patients
(8 dropouts - intention to treat)
COMPARISON
Controls ✅ - placebo controls
Randomization ✅
Protocols/ training ✅
Comparability of groups ✅
MEASUREMENT
Training ✅
Blinding -
Multiple observers -
Duplication -