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 .
The Effect of Erythromycin on Bile Excretion and Proximal Small Bowel Motility Following Divided Gastric Bypass Surgery: A Prospective Randomized Placebo-Controlled Trial
Background : No conclusive data exists supporting the use of any prokinetic agent in the postoperative setting . The study was design ed to examine the effect of erythromycin on small bowel motility in a placebo-controlled trial of post gastric bypass patients utilizing a st and ardized nuclear medicine test . Methods : A consecutive series of 21 patients undergoing elective gastric bypass surgery for morbid obesity between September 1999 and March 2001 were enrolled in this prospect i ve double-blind r and omized controlled trial . St and ard open , divided gastric bypass was performed . Patients were r and omized to receive either erythromycin 250 mg I. V. ( 11 patients ) or placebo ( 10 patients ) every 8 hours . On postoperative day 2 , a  hepatic iminodiacetic acid ( HIDA ) scan was obtained . Tracer movement through the biliary tree and proximal small bowel was quantified and compared . Results : Tracer clearance from the liver and biliary tree was no different between groups from time of injection through 1 hour . Tracer material clearance from the duodenum into the jejunum was no different between the erythromycin and control groups at 1 hour , 37 % ±13 % and 37 % ±22 % respectively ( P=0.95 ) . At 4 hours , clearance was greater in the erythromycin group , 77%±6 % , compared to control , 60%±20 % ( P = 0.036 ) . The rate of tracer change between hour 1 and 4 ( slope ) was steeper in the erythromycin group ( P=0.048 ) . Conclusions : Erythromycin  increases intestinal transit in the postoperative setting
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 .