Previous research has shown that gum-chewing has a beneficial effect on the activity of bowel functioning. However, this study concludes that gum-chewing after laparoscopic gastrectomy does not have an effect on the recovery process of gastrointestinal functioning.
Over a long period of time, finding a way to increase the speed of recovery of gastrointestinal function after surgery was a significant process that needed improvement. Patients undergoing abdominal surgery experienced exhaustion postoperative ileus (POI), which refers to the delayed release of feces, lasting 3-5 days. It can result in pain, abdominal discomfort, vomiting and can delay the speed of recovery after gastrointestinal surgery. This prolongs the continuation of regular bowel movements and makes the recovery process after surgery slower. Moreover, it can result in extended hospital stays, infections, deep vein thrombosis, issues related to the lungs and more hospital costs. Often, many drugs, epidural anesthesia, and nasogastric tubes are used as pain control and to help with recovery.
Recent studies presented that chewing gum can stimulate gastrointestinal contractions of the muscles, which is said to reduce POI. On the contrary, other findings refute the effects of gum-chewing on movement of the gastrointestinal tract and digestive system stimulation after gastrectomy. Therefore, the aim of this current study, published in the Medicine journal, was to analyze the effectiveness of gum-chewing on restoring postoperative bowel function in gastric cancer patients who received laparoscopic gastrectomy.
The study was a prospective, single-center, randomized, controlled clinical trial. It consisted of 75 adult patients with gastric cancer that received laparoscopic surgery in Shanghai Tongji hospital from March 2014 to March 2016. After eligibility of the participant’s selection, they were randomly separated by a 1:1 ratio of a gum-chewing (38 participants) or no gum chewing (control group of 37 participants), using a computer-generated sequence to randomize the groups to avoid biases. The patients in the gum group chewed sugarless gum for at least 15 minutes at 7:00, 12:00 and 18:00 from the first postoperative day and continued until the day of defecation (the discharge of feces from the body), which was approximately seven days. The patients in the no gum group received medical treatment with ward care. After 24 hours of surgery, the nasogastric tube was removed and patients of both groups were allowed to receive a clear-liquid diet. 24-hour intervals were used to record the first time of defecation, the incidence of POI, pain scores, nausea, vomiting scores and analgesic drug use. Additionally, to reduce biases amongst both groups, there were no differences in sex, age, American Society of Anesthesiologists (ASA) grade and chronic diseases (i.e. hypertension, type 2 diabetes mellitus, post-stroke syndrome and coronary artery disease).
The results from this study showed that the rates of POI, patient-controlled analgesia with fentanyl administration and the mean time of the onset of gas passage or defecation of both groups did not significantly differ. Another finding was that the 48-hour postoperative pain scores in the gum group were significantly higher. However, the 24- and 72-hour after pain scores were not significantly different between the two groups. Another evaluation observed was nausea and vomiting scores at 24, 48, 72 and after 72 hours, which did not show a significant difference.
Even though gum-chewing is one of the recommended treatments for POI, there is no consensus on its effectiveness for lessening the time of recovery and assisting with defecation. On the other hand, it should be noted that other results from different studies show the opposite of what was concluded in this study. Therefore, more research needs to be done in this area. The results suggest that each patient’s body reacts differently to various forms of treatment. This study presents three reasons that may explain why gum-chewing does not improve gastrointestinal recovery in patients with gastric cancer. Firstly, the nerve trunks were divided during gastrectomy, which may block the cephalic- vagal response causing gum-chewing to be ineffective. Secondly, chewing on gum mimics actual food consumption which would offset a normal early- feeding routine system which could delay bowel movements. Lastly, gum-chewing is not a strong enough method of testing to observe after a laparoscopy.
Limitations included; all patients being treated in a single hospital, it was a single-blinded randomized control trial, the patients knew they were not blinded and the documented time of defecation was not accurate. Thus, this study recommended not chewing gum after receiving laparoscopic gastrectomy as further randomized and controlled trials need to be conducted. Also, in addition to it not helping to hasten the process of recovery, it can also cause more pain on the second postoperative day.
Written By: Seema N. Goolie, BSc