Effects of gum chewing on postoperative bowel motility after caesarean section: a meta‐analysis of randomised controlled trials

Abstract

Background Gum chewing has been reported to enhance bowel motility and reduce postoperative ileus (POI). However, the efficacy remains imprecise for women following caesarean section.Objectives To summarise and evaluate the current evidence for postoperative gum chewing on the recovery of bowel function following caesarean section.Search strategy We searched studies from the following electronic databases: PubMed, EMBASE, SCOPUS and Cochrane Library from inception to 30 May 2013.Selection criteria We included randomised controlled trials (RCTs) of women after caesarean section; these RCTs should compared gum chewing with no gum chewing and reported on at least one of the outcomes: time to flatus, time to bowel sound, time to passing stool and length of hospital stay (LOS).Data collection and analysis Study outcomes were presented as mean differences (for continuous data) with 95% confidence interval (95% CI). The risk of bias in the study results was assessed using the assessment tool from the Cochrane Handbook.Main results Six RCTs including 939 women were included in our meta-analysis. The pooled results demonstrated that gum chewing is superior to no gum chewing with a reduction of 6.42 hours (95% CI À7.55 to À5.29) for time to first flatus, 3.62 hours (95% CI À6.41 to À0.83) for time to first bowel sound, 6.58 hours (95% CI À10.10 to À3.07) for time to first stool and 5.94 hours (95% CI À9.39 to À2.49) for LOS. In addition, no evidence emerged for any side effects caused by gum chewing.Conclusions The current evidence suggests that gum chewing is associated with early recovery of bowel motility and shorter LOS for women after caesarean section. This safe and inexpensive intervention should be included in routine postoperative care following a caesarean section.Keywords Caesarean section, gum chewing, ileus, meta-analysis, postoperative.Please cite this paper as: Zhu Y-P, Wang W-J, Zhang S-L, Dai B, Ye D-W. Effects of gum chewing on postoperative bowel motility after caesarean section: a meta-analysis of randomised controlled trials. BJOG 2014;121:787-792.

The biochemistry of saliva throughout pregnancy

“…Interestingly, recent studies show that chewing gum induces no changes in gastric pH 28,29 and is associated with early recovery of bowel motility and shorter length of hospital stay for women after caesarean section. 30 Regarding the other parameters analysed in saliva, namely salivary flow rate, calcium, phosphate, sodium, potassium, and α-amylase, different results have been reported, and together with our study, no consensus has emerged. The differences in the reported values may be justified by normal intra-individual changes of saliva content that may be linked to the circadian rhythms, menstrual cycle, eating habits, therapeutic drugs, etc.…”

Chewing gum for intestinal function recovery after caesarean section: a systematic review and meta-analysis

“…A recent meta-analysis by Huang [12] included only five RCTs involving 882 patients, the sample size and number of included studies were small. An earlier meta-analysis by Hochner [15] also included five RCTs with a total of 846 participants, the process for meta-analysis was rather strict, yet the publication bias could not be evaluated quantitatively by a funnel plot due to the small number of studies available, the other meta-analyses [14, 16, 17] also had problems in this area. Another comprehensive Cochrane meta-analysis [13] identified 81 studies involving 9072 participants to investigate whether the chewing gum after surgery hasten the return of gastrointestinal function after abdominal surgery, come to the finding that gum chewing showed a beneficial impact on the major outcomes of digestive system activation, including bowel sound, flatus passage and bowel movement, yet the including studies were rather heterogeneous.…”

Role of Chewing Gum on Early Recovery of Females After Caesarean Section

“…This safe and low cost intervention should be inculcated as a part of routine protocol postoperatively. 24 Another meta-analysis is of the opinion that chewing gum for 30 -60 minutes thrice daily is helpful in reduction of post operative ileus. A previous metaanalysis comprising of seventeen randomized controlled trials showed similar results in terms of parameters evaluated in the previous and index studies .…”