PARALYTIC ILEUS is a common complication of gastrointestinal (GI) surgery. In fact, it's so common that many consider some degree of postoperative ileus to be a normal physiologic response to abdominal surgery.1
This article explores whether the simple intervention of gum chewing can help prevent it. Let's start by taking a closer look at ileus.
Signs and symptoms of prolonged postoperative ileus include one or more of the following lasting longer than 3 to 5 days postoperatively:
- abdominal distension
- nausea and vomiting
- diffuse, persistent abdominal pain
- intolerance of an oral diet
- delayed passage or absence of flatus.1,2
Postoperative ileus leads to extended hospital stays, which increase the occurrence of other complications, such as healthcare-associated infections and venous thromboembolism.3 The cost of extended hospitalization due to postoperative ileus is estimated to be between $750 million and $1 billion a year.2
Treatment for this condition is supportive, consisting of N.P.O. status, gastric decompression via a nasogastric tube, I.V. fluids and electrolytes, pain management that minimizes opioids, continued monitoring, and simply waiting for the ileus to resolve.2
Attempts to prevent paralytic ileus rely on the theory of sham feeding. The physiologic process behind this theory is that chewing stimulates the vagus nerve, which promotes peristalsis and the release of normal GI tract hormones. Previous ileus prevention efforts relying on the sham feeding theory focused on encouraging oral intake soon after surgery.2
Although the effectiveness of early feeding varies, many patients simply can't tolerate early feedings after abdominal surgery.2 Gum chewing has been proposed as a cost-effective and easy-to-implement intervention to reduce the incidence of postoperative ileus following abdominal surgery.
Benefits of chewing gum
Research shows that patients who chew gum after surgery experience a faster return of bowel function and pass flatus significantly sooner than those who don't chew gum.3 Compared with patients who are N.P.O., patients who chew gum after surgery also have a faster return of bowel sounds and have their first bowel movement significantly sooner.4 These findings were supported by a 2009 meta-analysis.5
The effect of gum chewing on bowel motility is so significant that it's being used successfully in nonsurgical situations. For example, some healthcare providers have used gum chewing to speed the travel time for capsule endoscopy.2
Postop gum chewing also improves how patients feel after surgery. Those who are fed soon after surgery are more likely to experience vomiting than those who are allowed to chew gum.6 Postop patients who chew gum after surgery also feel hungry significantly sooner than those who were N.P.O.4
By causing bowel function to return faster, gum chewing reduces the duration of the hospital stay after surgery: Postop patients who chew gum are discharged from the hospital sooner than patients who remain N.P.O. after surgery.6 Gum chewing significantly decreases hospital lengths of stay by about 1 to 2 days.7
The success of postop gum chewing seems to depend on the type of surgery in question. Gum chewing is more successful in laparoscopic surgeries than in open surgeries, and it has little benefit after surgeries that reduce the stomach, such as gastrectomies.2
Sizing up the risks
Gum chewing is an easy-to-implement intervention that's generally safe, simple, effective, and inexpensive. However, it's not without risks. If aspirated, gum can cause airway obstruction and potential cardiac arrest. Sorbitol and other ingredients in sugar-free gum can also cause signs and symptoms such as headaches, vasculitis, and diarrhea.2 Gum chewing after GI surgery should be prescribed by a healthcare provider after determining its appropriateness and evaluating the risks, benefits, and alternatives. Additionally, nurses should assess level of consciousness and ability to swallow before administering gum to a patient.
Chew on these facts
The benefits of encouraging patients to chew gum following abdominal surgery are clear. A faster return to normal bowel function and reduction in nausea and vomiting mean that patients feel better after surgery. When patients feel better, they're far more likely to participate in their own recovery and may be discharged faster.
Gum chewing is certainly a useful strategy in reducing the incidence of postoperative ileus. However, most research doesn't provide recommendations about the frequency and duration of gum chewing or the type of gum that should be used, and the effects of gum chewing in patients with nasogastric tubes haven't been studied. Nurses are in a key position to conduct additional research and to advocate for the use of gum chewing for postop patients.
1. Litkouhis B.Postoperative ileus. UpToDate. 2013. http://www.uptodate.com
2. Fitzgerald JE, Ahmed I. Systematic review and meta-analysis of chewing-gum therapy in the reduction of postoperative paralytic ileus following gastrointestinal surgery. World J Surg
3. Jang SY, Ju EY, Kim DE, et al. First flatus time and xerostomia associated with gum-chewing after liver resection. J Clin Nurs
4. Marwah S, Singla S, Tinna P. Role of gum chewing on the duration of postoperative ileus following ileostomy closure done for typhoid ileal perforation: a prospective randomized trial. Saudi J Gastroenterol
5. 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
6. Askarpour S, Shoushtari M, Saadati M. Study of the effect of early feeding, chewing gums, and laxative on ileus in patients who underwent open cholecystectomy. Internet J Surg
. 2010;22(2). http://ispub.com/IJS/22/2/9675
7. Lafon C, Lawson L. Gum chewing as a strategy to reduce the duration of postoperative ileus. Gastrointestinal Nurs