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 .
Treatment of postoperative ileus after bowel surgery with low-dose intravenous erythromycin.
OBJECTIVES Treatment of postoperative ileus remains unsatisfactory . Erythromycin ( EM ) , a macrolide antibiotic , has prokinetic effects on the gut . We investigated whether intravenous erythromycin decreases the time to the return of normal bowel function after bowel surgery in patients with bladder cancer and interstitial cystitis who have undergone cystectomy and urinary diversion . METHODS We conducted a double-blind , r and omized , placebo-controlled study of 22 volunteers . On the first postoperative day , patients began receiving intravenous erythromycin ( 125 mg ) or placebo every 8 hours ( maximum of 21 doses ) . The patients ' ability to tolerate a general diet and return of bowel function was monitored . RESULTS A general diet was tolerated at a median of 9 days postoperatively for the EM arm and 8 for the placebo arm ( P = 0.60 ) . The first bowel sounds were detected at an average of 2 postoperative days for the EM arm and 3 for the placebo arm ( P = 0.88 ) . First flatus was present an average of 5 days postoperatively for both study arms ( P = 0.35 ) . The first bowel movement was present an average of 6 days postoperatively for the EM arm and 5 for the placebo arm ( P = 0.98 ) . CONCLUSIONS No significant difference was found between EM and placebo with regard to the onset of bowel sounds , passage of flatus , passage of the first bowel movement , and the time to tolerate a general diet . These data indicate that erythromycin is not useful in improving postoperative bowel function
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 .