Title: A randomised trial of gum chewing to reduce post-operative ileus
Funder: Department of Health (England)

Abstract: Background Post-operative ileus remains a serious clinical problem that delays patient recovery following colorectal surgery. Several feeding strategies have been examined in an attempt to reduce ileus but are generally not well tolerated. Small studies have investigated the effectiveness of chewing sugar-free gum, as a form of sham feeding, with encouraging results. Overall, those chewing gum passed flatus 21 hours earlier, had a bowel movement 33 hours earlier, and were discharged 2 days earlier than patients randomised to usual care. However, an adequately powered, methodologically rigorous trial is required to confirm these findings, and to assess whether reported benefits also result in differences in clinical outcomes (e.g., infection), costs of care, and patient-reported quality of life. Aims The overarching aim of this study is to examine the potential benefits of chewing sugar-free gum on post-operative ileus in patients who have undergone large bowel resection. The primary aim is to determine whether post-operative chewing gum reduces the length of hospital stay. Secondary aims are to determine the effects of chewing gum on a number of other important, although less commonly studied, outcomes including clinical factors (e.g., vomiting, infections, and anastomotic dehiscence), quality of life, and cost effectiveness. We will also assess outcome measures reported in other studies such as time to first flatus and first bowel movement, in addition to factors such as patient acceptability and compliance. Plan of Investigation A total of 400 patients attending for elective large bowel resection (due to colorectal cancer, ulcerative colitis, or diverticular disease) will be randomised to receive usual care or usual care plus chewing gum. Patients will be recruited at two centres: the Bristol Royal Infirmary and the Derriford Hospital, Plymouth. Those randomised to gum will be asked to chew a piece of sugar-free gum for 10 minutes three times a day, starting on the first post-operative morning until the time of second bowel movement. Data will be collected primarily from medical record review and from patient questionnaires administered during the week following their operation, and at 6 weeks and 3 months post-randomisation. All data analyses will be conducted on an intention-to-treat basis. Potential Impact Post-operative ileus is a universal complication of abdominal surgery, with unfavourable consequences for both patients and healthcare systems We propose a trial of post-operative chewing gum as a means of reducing the duration of ileus which, if successful, will have considerable impact on patient care. Benefits would include a reduction in length of hospital stay and a reduction in the incidence of adverse clinical outcomes with high morbidity. If such benefits are observed, the findings of this trial could ultimately lead to changes in the post-operative care of patients undergoing abdominal surgery. Gum chewing may be an inexpensive and safe option for the reduction of post-operative ileus.


Research activity codes: 6.7 PHYSICAL
Health categories: ORAL AND GASTROINTESTINAL