Effect of Gum Chewing on Bowel Motility in Patients with Colorectal Cancer after Open Colectomy: A Randomized Controlled Trial

Authors

  • Cherdsak Duangchan Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok 10700 http://orcid.org/0000-0001-8168-3074
  • Tipa Toskulkao Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok 10700
  • Suporn Danaidutsadeekul Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok 10700 http://orcid.org/0000-0003-1726-0864
  • Cherdsak Iramaneerat Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700 http://orcid.org/0000-0002-2750-3981

Keywords:

Gum chewing, bowel motility, recovery, colorectal cancer, colectomy

Abstract

Background: Postoperative ileus (POI) usually delays the postoperative recovery after open colectomy. Gum chewing may facilitate bowel motility through cephalic-vagal stimulation. Bowel sounds, the time to first postoperative flatus and defecation, the common nursing outcomes of bowel motility, has not been investigated in Thai patients. This study examines the effect of gum chewing on bowel motility in colorectal cancer patients after open colectomy.
Methods: A single blind randomized controlled trial was conducted with 32 patients in experimental and 32 patients in control groups. The experimental group chewed a piece of sugar-free gum with a fruity flavor for 20 minutes each time, three times a day starting from the first postoperative day till the date of first oral liquid received, while the control group receive routine care.
Results: The bowel sounds of the experimental group after chewing gum significantly increased more than those of the control group (p = 0.00). The time to the first postoperative flatus in the experimental group was significantly shorter than that in the control group; likewise the first postoperative defecation was also shorter (p = 0.04, p = 0.02, respectively).
Conclusion: Gum chewing is helpful in stimulating bowel motility measured by an increase in bowel sounds and in reduced times to first postoperative flatus and defecation. This nursing intervention may be used for stimulating bowel motility in patients with colorectal cancer after an open colectomy.

References

1. Kehlet H, Holte K. Review of postoperative ileus. Am J Surg 2001;182(5A Suppl):3S-10S.
2. Goldstein JL, Matuszewski KA, Delaney CP, Senagore A, Chiao EF, Shah M, et al. Inpatient Economic Burden of Postoperative Ileus Associated with Abdominal Surgery in the United States. P&T 2007;32:82-90.
3. Luckey A, Livingston E, Taché Y. Mechanisms and treatment of postoperative ileus. Arch Surg 2003;138:206-14.
4. Resnick J, Greenwald DA, Brandt LJ. Delayed gastric emptying and postoperative ileus after nongastric abdominal surgery: part I. Am J Gastroenterol 1997;92:751-62.
5. Espat NJ, Cheng G, Kelley MC, Vogel SB, Sninsky CA, Hocking MP. Vasoactive intestinal peptide and substance P receptor antagonists improve postoperative ileus. J Surg Res 1995;58:719-23.
6. Holte K, Kehlet H. Postoperative ileus: a preventable event. Br J Surg 2000;87:1480-93.
7. Person B, Wexner SD. The Management of Postoperative Ileus. Curr Probl Surg 2006;43:12-65.
8. Senagore AJ. Pathogenesis and clinical and economic consequences of postoperative ileus. Am J Health Syst Pharm 2007;64(20 Suppl 13):S3-7.
9. Iyer S, Saunders WB, Stemkowski S. Economic burden of postoperative ileus associated with colectomy in the United States. J Manag Care Pharm 2009;15:485-94.
10. Delaney C, Kehlet H, Senagore AJ, Bauer AJ, Beart R, Billingham R, et al. Postoperative Ileus: Profiles, Risk Factors, and Definitions—A Framework for Optimizing Surgical Outcomes in Patients Undergoing Major Abdominal and Colorectal Surgery. Clinical Consensus Update in General Surgery 2006:1-26.
11. Asao T, Kuwano H, Nakamura J, Morinaga N, Hirayama I, Ide M. Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy. J Am Coll Surg 2002;195:30-32.
12. Schuster R, Grewal N, Greaney GC, Waxman K. Gum chewing reduces ileus after elective open sigmoid colectomy. Arch Surg 2006;141:174-6.
13. Hirayama I, Suzuki M, Ide M, Asao T, Kuwano H. Gum-chewing stimulates bowel motility after surgery for colorectal cancer. Hepatogastroenterology 2006;53:206-8.
14. Matros E, Rocha F, Zinner M, Wang J, Ashley S, Breen E, et al. Does gum chewing ameliorate postoperative ileus? Results of a prospective, randomized, placebo-controlled trial. J Am Coll Surg 2006;202:773-8.
15. McCormick JT, Garvin R, Caushaj P, Simmang C, Gregorcyk S, Huber P, et al. The effects of gum-chewing on bowel function and hospital stay after laparoscopic vs open colectomy: a multi-institution prospective randomized trial. J Am Coll Surg 2005;201:S66-7.
16. Pooreesathian K. Gum chewing reduces postoperative ileus after open colectomy. Thai J Surg 2008;29:118.
17. Quah HM, Samad A, Neathey AJ, Hay DJ, Maw A. Does gum chewing reduce postoperative ileus following open colectomy for left-sided colon and rectal cancer? A prospective randomized controlled trial. Colorectal Dis 2006;8:64-70.
18. Kobayashi T, Masaki T, Kogawa K, Matsuoka H, Sugiyama M. Effect of gum chewing on bowel movement after open colectomy for left-sided colorectal cancer: A Randomized clinical trial. Dis Colon Rectum 2015;58:1058-63.
19. Mattei P, Rombeau JL. Review of the pathophysiology and management of postoperative ileus. World J Surg 2006;30:1382-91.
20. Hochner H, Tenfelde SM, Abu Ahmad W, Liebergall-Wischnitzer M. Gum chewing and gastrointestinal function following caesarean delivery: a systematic review and meta-analysis. J Clin Nurs 2015;24:1795-804.
21. Sherwood L. The Peripheral Nervous System: Afferent Division; Special Senses. In: Sherwood L, editor. Human Physiology: From Cells to Systems. 7 ed. KY: Brooks/Cole Cengage Learning; 2010. p. 183-235.
22. Noble EJ, Harris R, Hosie KB, Thomas S, Lewis SJ. Gum chewing reduces postoperative ileus? A systematic review and meta-analysis. Int J Surg 2009;7:100-5.
23. Oghe H, Levitt MD. Intestinal Gas. In: Feldman M, Friedman LS, Brandt LJ, editors. Gastrointestinal and liver disease: pathophysiology/diagnosis/management. 8th ed. Philadelphia: Saunders Elsevier; 2006. p. 187-98.
24. Lohsiriwat S. Gastrointestinal Physiology. In: Jiasakul S, Lohsiriwat S, Wattanapa W, editors. Physiology. 2nd. Bangkok: Ruenkaew; 1998. p. 585-670. (in Thai)
25. Wang XJ, Chi P. Effect of chewing gum on the promotion of intestinal function recovery after colorectal surgery: a meta-analysis. Zhonghua Wei Chang Wai Ke Za Zhi 2013;16:1078-83.
26. Vásquez W, Hernández AV, Garcia-Sabrido JL. Is gum chewing useful for ileus after elective colorectal surgery? A systematic review and meta-analysis. J Gastrointest Surg 2009;13:649-56.
27. Purkayastha S, Tilney HS, Darzi AW, Tekkis PP. Meta-analysis of randomized studies evaluating chewing gum to enhance postoperative recovery following colectomy. Arch Surg 2008;143:788-93.
28. de Castro SM, van den Esschert JW, van Heek NT, Dalhuisen S, Koelemay MJ, Busch OR, et al. A systematic review of the efficacy of gum chewing for the amelioration of postoperative ileus. Dig Surg 2008;25:39-45.
29. Chan MK, Law WL. Use of chewing gum in reducing postoperative ileus after elective colorectal resection: a systematic review. Dis Colon Rectum 2007;50:2149-57.
30. Parnaby CN, MacDonald AJ, Jenkins JT. Sham feed or sham? A meta-analysis of randomized clinical trials assessing the effect of gum chewing on gut function after elective colorectal surgery. Int J Colorectal Dis 2009;24:585-92.

Downloads

Published

08-05-2020

How to Cite

Duangchan, C. ., Toskulkao, T. ., Danaidutsadeekul, S. ., & Iramaneerat , C. (2020). Effect of Gum Chewing on Bowel Motility in Patients with Colorectal Cancer after Open Colectomy: A Randomized Controlled Trial. Siriraj Medical Journal, 68(3), 135–141. Retrieved from https://he02.tci-thaijo.org/index.php/sirirajmedj/article/view/242687

Issue

Vol. 68 No. 3 (2016): May-June

Section

Original Article

License

Users are free to share, copy, and redistribute all articles published in the Siriraj Medical Journal (SMJ) in any medium or format as long as you follow the following terms:

  • Attribution — You must give appropriate credit, provide a link to the material, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the publisher endorses you or your use.
  • NonCommercial — You may not use the material for commercial purposes.
  • NoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.
  • No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.