The Effect of Chewing Gum on Nausea, Vomiting and Bowel Function After Colorectal Surgery

Study Overview
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Brief Summary
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False feeding refers to promoting gastrointestinal peristalsis by seeing, smelling, chewing, and tasting food, not getting food into the gastrointestinal tract. Postoperative sham feeding uses gum to promote the healing of gastrointestinal peristalsis. Although not fully understood, the physiological theory underlying gum chewing (fake feeding) to stimulate peristalsis and reduce postoperative intestinal recovery time is that the oral and chewing stimulation provided by chewing gum stimulates a neurohumoral reflex that increases gastrointestinal fluid secretion. This increases gastrointestinal motility. In addition, oral stimulation and chewing can stimulate the vagus nerve, which is also involved in promoting peristalsis. Finally, none of the existing theories adequately explain the effect of chewing/gum chewing on reducing postoperative inflammation in the gut, which may result in a reduced incidence of postoperative infection. In previous studies, physiological changes associated with gum appear to promote normal gastrointestinal function and subsequent postoperative/anesthetic recovery. Although many studies have been conducted to examine the effectiveness of chewing gum in patients undergoing colorectal resection, the results have been inconsistent. This can be attributed to differences in intestinal injuries affecting bowel function, differences in time under anesthesia and differences in anesthetics or pain control agents used for pain control affecting bowel function, and recovery time of peristalsis. Given the many factors known to affect postoperative ileus, chewing gum as an intervention remains a safe, accessible, and inexpensive option that remains to be explored.

Detailed Description
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False feeding refers to promoting gastrointestinal peristalsis by seeing, smelling, chewing and tasting food, not getting food into the gastrointestinal tract. Postoperative sham feeding uses gum to promote healing of gastrointestinal peristalsis. Although not fully understood, the physiological theory underlying gum chewing (fake feeding) to stimulate peristalsis and reduce postoperative intestinal recovery time is that the oral and chewing stimulation provided by chewing gum stimulates a neurohumoral reflex that increases gastrointestinal fluid secretion. This increases gastrointestinal motility. In addition, oral stimulation and chewing can stimulate the vagus nerve, which is also involved in promoting peristalsis. Finally, none of the existing theories adequately explain the effect of chewing/gum chewing on reducing postoperative inflammation in the gut, which may result in a reduced incidence of postoperative infection. Previous studies have shown that physiological changes associated with gum support normal gastrointestinal function and subsequent postoperative/anesthetic recovery. Some studies have shown that chewing gum after colorectal resection reduces postoperative flatulence and defecation time. showed that it reduces the risk of postoperative ileus. In contrast, some studies in patients undergoing open abdominal surgery or laparoscopy for various types of colorectal resection have shown no effect of chewing gum on postoperative first flatulence and time to defecation, has no significant effect in reducing the average hospital stay and has no significant effect in preventing postoperative nausea, vomiting, or bloating. One possible reason for the inconsistent results of sham feeding using chewing gum to reduce the incidence of postoperative ileus may be differences in underlying colorectal cancer types and heterogeneity between surgical and postoperative care methods. Although many studies have been conducted to examine the effectiveness of chewing gum in patients undergoing colorectal resection, the results have been inconsistent. This can be attributed to differences in intestinal injuries affecting bowel function, differences in time under anesthesia differences in anesthetics or pain control agents used for pain control affecting bowel function, and recovery time of peristalsis. Given the many factors known to affect postoperative ileus, chewing gum as an intervention remains a safe, accessible, and inexpensive option that remains to be explored. This study will provide empirical evidence that contributes to a body of literature supporting gum administration for affecting postoperative nausea, flatulence, and stool output in a well-defined sample. Many interventions and strategies have been used to manage postoperative ileus, such as prokinetic agents and epidural anesthesia. However, these methods have limited efficacy and still have a relatively high incidence of postoperative ileus. Alternatively, chewing gum promotes gastrointestinal peristalsis in post-surgery patients without the adverse effects associated with early feeding. However, results in studies investigating the effect of chewing gum on postoperative recovery of gastrointestinal function after colorectal surgery are conflicting.

Official Title
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The Effect of Chewing Gum on Nausea, Vomiting and Bowel Functions After Colorectal Surgery: A Randomized Clinical Study

Conditions
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Postsurgical Ileus

Intervention / Treatment
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* Other: gum chewing


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Being over 18 years old, To have applied for elective colorectal surgery, Having undergone laparoscopic colorectal surgery, Not having a nasogastric insertion, Not having a vision-hearing problem, ECOG performance score to be between 0-2, Exclusion Criteria: Performing emergency surgical intervention, Open colorectal surgery Need for intensive care after surgery, Stoma has been opened

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: The study was planned as a prospective, single-blind, parallel-group, randomized controlled study.
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: gum chewing<br>All participants will receive standard postoperative care, 2 L/min of oxygen delivered via nasal cannula if oxygen saturation is below 95%. In addition, participants will be encouraged to use the incentive spirometer 10 times per hour to prevent respiratory complications such as pneumonia. In the postoperative period, all participants will be removed from bed and mobilized as soon as possible. For the patients in the experimental group, sugar-free xylitol gum containing 1.2-1.37 grams of xylitol per piece, available in the market, will be used. Participants in the experimental group will start chewing gum on the first postoperative day and will be allowed to chew a single piece of gum 3 times a day at 9:00, 14:00 and 19:00, respectively, for 15 minutes. The gum will be given to the participants regularly by a researcher until the first reported flatulence. | Other: gum chewing<br>* For the patients in the experimental group, sugar-free xylitol gum containing 1.2-1.37 grams of xylitol per piece, available in the market, will be used. Participants in the experimental group will start chewing gum on the first postoperative day and will be allowed to chew a single piece of gum 3 times a day at 9:00, 14:00 and 19:00, respectively, for 15 minutes. The gum will be given to the participants regularly by a researcher until the first reported flatulence.<br>|
| No Intervention: control group<br>All participants will receive standard postoperative care, 2 L/min of oxygen delivered via nasal cannula if oxygen saturation is below 95%. In addition, participants will be encouraged to use the incentive spirometer 10 times per hour to prevent respiratory complications such as pneumonia. In the postoperative period, all participants will be removed from bed and mobilized as soon as possible. The control group will receive only standard care. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| prevention of postoperative ileus | The first postoperative gas removal time and the first postoperative stool removal time will be questioned by the researcher. There is no standard scale for this. | 72 hours | 
| Prevention of nausea-vomiting. | Nausea and Vomiting Evaluation Form. In our study, PONV status will be evaluated as Yes/No at 0, 2, 4, 8, 12 and 24 hours using the Nausea and Vomiting Evaluation Form. | 72 saat | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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postsurgical ileus, chewing gum, colorectal surgery