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 .
Prokinetic effect of erythromycin after colorectal surgery
PURPOSE : Nausea and vomiting three to seven days after an elective operation on the colon and rectum remain a persistent clinical problem . Erythromycin , a safe , inexpensive drug that stimulates intestinal motilin receptors , has previously been shown to accelerate gastric emptying significantly after upper gastrointestinal surgery . We aim ed to evaluate the effect of postoperative intravenous erythromycin on postoperative ileus in patients undergoing elective surgery for primary colorectal cancer . METHODS : Between May 1998 and April 1999 , 150 patients undergoing primary resection of colon or rectal cancer were enrolled in this prospect i ve , r and omized , placebo-controlled trial . One hundred thirty-four patients completed the study . Patients were excluded if they had extensive metastatic disease , were taking medications known to interact with erythromycin , or if they required an ileostomy . Patients received either 200 mg of intravenous erythromycin or placebo every six hours . Clinical endpoints were recorded and continuous endpoints are presented as mean ± st and ard deviation . RESULTS : There were no significant complications related to erythromycin . The erythromycin ( n=65 ) and placebo ( n=69 ) groups were comparable regarding demographic and operative factors . The erythromycin group had a slightly shorter length of time to passage of flatus ( 4.1 ± 1.3vs . 4.4 ± 1.1 days;P=0.03 ) . There was no significant difference between erythromycin and placebo  in time to first solid food ( 5.6 ± 1.9vs . 5.4 ± 1.8 days ) , time to first bowel movement ( 5.2 ± 1.9vs . 5.4 ± 1.3 days ) , or time to discharge from hospital ( 7.5 ± 2.0vs . 7.6 ± 2.8 days ) . There was no difference in the rate of clinical ly significant nausea ( 26vs . 26 percent;P=0.99 ) , vomiting ( 17vs . 16 percent;P=0.88 ) , or nasogastric tube placement ( 9vs . 7 percent;P=0.68 ) . CONCLUSIONS : Erythromycin does not seem to alter clinical ly important outcomes related to postoperative ileus in patients undergoing resection for colorectal cancer
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 .