Effect of sham feeding with gum chewing on postoperative ileus after liver transplantation—a randomized controlled trial

Abstract

Postoperative ileus (POI) is a common complication after major abdominal surgery. Gum chewing has been shown to stimulate bowel motility and decrease duration of POI after abdominal surgery. We evaluated the effect of gum chewing in reducing the time to first flatus and on oral calorie intake in patients undergoing living or deceased donor liver transplantation. Patients were randomized into the sham feeding group or the control group. The sham feeding group chewed two pieces of xylitol flavored gum for 15 minutes, three times a day after extubation until oral nutrition was tolerated. The control group received the same routine care except for the gum chewing. Fifty-nine patients were randomized into the sham feeding group (n=30) or the control group (n=29). There was no difference in the time to first flatus (72 [66.1-82.9] hours vs 69.0 [57.6-77.2] hours, P=.422). Cumulative energy intake (2.8 [5.8-23.2] % vs 10.0 [8.5-15.9] %, P=.695) and length of intensive care unit stay (4.2 [3.9-5.3] days vs 4.0 [6.7-4.5] days, P=.077) were also similar. In conclusion, sham feeding with gum chewing did not shorten the duration of POI nor facilitate oral intake after liver transplantation. (Clinicaltrials.gov number: NCT 01956643).

Gum chewing aids bowel function return and analgesic requirements after bowel surgery: a randomized controlled trial

“…The precise mechanism whereby chewing gum enhances the return of gut function is also subject to scrutiny. The postulated mechanism is that chewing gum simulates sham feeding, resulting in increased gastric emptying and faster recovery of small intestinal function followed by large intestinal function, probably through neurohumoral mechanisms . This may not be correct.…”

“…Multiple randomized controlled trials (RCTs) have evaluated the effectiveness of chewing gum in the postoperative setting for many types of surgery, including colorectal, gastric, ileal and liver resections as well as appendicectomy, cystectomy, Caesarian section and gynaecological surgery [2,10,[13][14][15][16][17]. The results of these studies are heterogenous and most are underpowered with fewer than 80 patients per study.…”

The Efficacy of Chewing Gum in Postoperative Ileus Management After Robot Assisted Laparoscopic Radical Prostatectomy: A Prospective Randomized Study

“…[2] POI is the most common minor postoperative complication that causes morbidity and delays in the length of hospital stay and leads to increasing economic burden on health system. [3] Early feeding, chewing gum, nasogastric intubation, epidural anesthesia and analgesia, early mobilization and physical therapy methods have been tried for early acquisition of bowel mobilization. [4][5][6][7][8][9] However, these treatments could not come into routine use because of their limited clinical efficacy.…”

Chewing Stimulation Reduces Appetite Ratings and Attentional Bias toward Visual Food Stimuli in Healthy-Weight Individuals

“…Mastication/chewing could be one factor that increases satiation and reduces food intake ( Hetherington and Boyland, 2007 ; Hetherington and Regan, 2011 ; Li et al, 2011 ; Swoboda and Temple, 2013 ; Miquel-Kergoat et al, 2015 ). Several studies have reported appetite reduction by sham feeding (i.e., food is chewed but not eaten) ( Wijlens et al, 2012 ) and gum-chewing (also a type of sham feeding) ( Schuster et al, 2006 ; Xu et al, 2015 ; Lee et al, 2016 ). Such chewing stimulation includes motor activities of the jaws, saliva secretion, and intra- and extra-oral somatosensory stimulation.…”