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 .
Randomised trial of safety and efficacy of immediate postoperative enteral feeding in patients undergoing gastrointestinal resection
Abstract Objectives : To assess whether immediate postoperative enteral feeding in patients who have undergone gastrointestinal resection is safe and effective . Design : R and omised trial of immediate postoperative enteral feeding through a nasojejunal tube v conventional postoperative intravenous fluids until the re introduction of normal diet . Setting : Teaching hospitals in London . Subjects : 30 patients under the care of the participating consultant surgeon who were undergoing elective laparotomies with a view to gastrointestinal resection for quiescent , chronic gastrointestinal disease . Two patients did not proceed to resection . Main outcome measures : Nutritional state , nutritional intake and nitrogen balance , gut mucosal permeability measured by lactulose-mannitol differential sugar absorption test , complications , and outcome . Results : Successful immediate enteral feeding was established in all 14 patients , with a mean ( SD ) daily intake of 6.78 ( 1.57 ) MJ ( 1622 ( 375 ) kcal before re introduction of oral diet compared with 1.58 ( 0.14 ) MJ ( 377 ( 34 ) kcal ) for those on intravenous fluids ( P<0.0001 ) . Urinary nitrogen balance on the first postoperative day was negative in those on intravenous fluids but positive in all 14 enterally fed patients ( mean ( SD ) -13.2 ( 11.6 ) g v 5.3 ( 2.7 ) g ; P<0.005 ) . There was no difference by day 5 . There was no change in gut mucosal permeability in the enterally fed group but a significant increase from the test ratios seen before the operation in those on intravenous fluids ( 0.11 ( 0.06 ) v 0.15 ( 0.12 ) ; P<0.005 ) . There were also fewer postoperative complications in the enterally fed group ( P<0.005 ) . Conclusions : Immediate postoperative enteral feeding in patients undergoing intestinal resection seems to be safe , prevents an increase in gut mucosal permeability , and produces a positive nitrogen balance . Key messages Key messages It is safe , with patients experiencing fewer complications There seems to be an improvement in nutritional state Patients may have an improved
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 .