Neither metoclopramide nor erythromycin were effective in expediting the resolution of ileus .
Analyses of 32 r and omized controlled trials showed that EEN facilitates return of normal bowel function , achieving enteral nutrition goals , and reducing hospital length of stay .
CONCLUSION In patients who have undergone abdominal surgery , we strongly recommend EEN to expedite resolution of Ileus , but we can not recommend for or against the use of either metoclopramide or erythromycin to hasten the resolution of ileus in these patients .
BACKGROUND Ileus is a common challenge in adult surgical patients with estimated incidence to be 17 % to 80 % .
The main mechanisms of the postoperative ileus pathophysiology are fluid overload , exogenous opioids , neurohormonal dysfunction , gastrointestinal stretch , and inflammation .
Management includes addressing the underlying cause and supportive care .
Multiple medical interventions have been proposed , but effectiveness is uncertain .
A working group of the Eastern Association for the Surgery of Trauma aim ed to evaluate the effectiveness of metoclopramide , erythromycin , and early enteral nutrition ( EEN ) on ileus in adult surgical patients and to develop recommendations applicable in a daily clinical practice .
Effect of intravenous erythromycin on postoperative ileus.
We attempted to determine whether the administration of erythromycin shortens the period of postoperative ileus by a prospect i ve , double-blind , placebo-controlled study . Seventy-seven patients were r and omized and included in the statistical calculations . The patients were stratified according to the operation performed ( cholecystectomy , celiotomy , or other major abdominal operations ) . Forty-one patients ( group 1 ) received 250 mg erythromycin intravenously every 8 h for nine doses upon admission to the recovery room . Thirty-six patients ( group 2 ) received placebo . The time ( in hours ) to first passage of flatus , first liquid meal , first bowel movement , and total length of hospital stay was recorded . There was no significant difference between group 1 and group 2 in time to first flatus ( 54.9 + /- 29 vs. 53.9 + /- 27 h , respectively ) , first meal ( 70.4 + /- 44 vs. 71.7 + /- 65 ) , first bowel movement ( 81.8 + /- 32 vs. 80.1 + /- 28 ) , or length of hospital stay ( 185.2 + /- 183 vs. 182.1 + /- 163 ) . Erythromycin , in the dosage tested in this study , does not seem to alter clinical parameters of gastrointestinal motility after an abdominal operation . New prokinetic agents may deserve further studies
Neither metoclopramide nor erythromycin were effective in expediting the resolution of ileus .
Analyses of 32 r and omized controlled trials showed that EEN facilitates return of normal bowel function , achieving enteral nutrition goals , and reducing hospital length of stay .
CONCLUSION In patients who have undergone abdominal surgery , we strongly recommend EEN to expedite resolution of Ileus , but we can not recommend for or against the use of either metoclopramide or erythromycin to hasten the resolution of ileus in these patients .
BACKGROUND Ileus is a common challenge in adult surgical patients with estimated incidence to be 17 % to 80 % .
The main mechanisms of the postoperative ileus pathophysiology are fluid overload , exogenous opioids , neurohormonal dysfunction , gastrointestinal stretch , and inflammation .
Management includes addressing the underlying cause and supportive care .
Multiple medical interventions have been proposed , but effectiveness is uncertain .
A working group of the Eastern Association for the Surgery of Trauma aim ed to evaluate the effectiveness of metoclopramide , erythromycin , and early enteral nutrition ( EEN ) on ileus in adult surgical patients and to develop recommendations applicable in a daily clinical practice .