The Effect of Chewing Gum on Nausea, Vomiting and Bowel Function After Colorectal Surgery

March 2, 2024 updated by: Derya Gezer, Cukurova University

The Effect of Chewing Gum on Nausea, Vomiting and Bowel Functions After Colorectal Surgery: A Randomized Clinical Study

False feeding refers to promoting gastrointestinal peristalsis by seeing, smelling, chewing, and tasting food, not getting food into the gastrointestinal tract. Postoperative sham feeding uses gum to promote the healing of gastrointestinal peristalsis. Although not fully understood, the physiological theory underlying gum chewing (fake feeding) to stimulate peristalsis and reduce postoperative intestinal recovery time is that the oral and chewing stimulation provided by chewing gum stimulates a neurohumoral reflex that increases gastrointestinal fluid secretion. This increases gastrointestinal motility. In addition, oral stimulation and chewing can stimulate the vagus nerve, which is also involved in promoting peristalsis. Finally, none of the existing theories adequately explain the effect of chewing/gum chewing on reducing postoperative inflammation in the gut, which may result in a reduced incidence of postoperative infection. In previous studies, physiological changes associated with gum appear to promote normal gastrointestinal function and subsequent postoperative/anesthetic recovery. Although many studies have been conducted to examine the effectiveness of chewing gum in patients undergoing colorectal resection, the results have been inconsistent. This can be attributed to differences in intestinal injuries affecting bowel function, differences in time under anesthesia and differences in anesthetics or pain control agents used for pain control affecting bowel function, and recovery time of peristalsis. Given the many factors known to affect postoperative ileus, chewing gum as an intervention remains a safe, accessible, and inexpensive option that remains to be explored.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

False feeding refers to promoting gastrointestinal peristalsis by seeing, smelling, chewing and tasting food, not getting food into the gastrointestinal tract. Postoperative sham feeding uses gum to promote healing of gastrointestinal peristalsis. Although not fully understood, the physiological theory underlying gum chewing (fake feeding) to stimulate peristalsis and reduce postoperative intestinal recovery time is that the oral and chewing stimulation provided by chewing gum stimulates a neurohumoral reflex that increases gastrointestinal fluid secretion. This increases gastrointestinal motility. In addition, oral stimulation and chewing can stimulate the vagus nerve, which is also involved in promoting peristalsis. Finally, none of the existing theories adequately explain the effect of chewing/gum chewing on reducing postoperative inflammation in the gut, which may result in a reduced incidence of postoperative infection. Previous studies have shown that physiological changes associated with gum support normal gastrointestinal function and subsequent postoperative/anesthetic recovery.

Some studies have shown that chewing gum after colorectal resection reduces postoperative flatulence and defecation time. showed that it reduces the risk of postoperative ileus. In contrast, some studies in patients undergoing open abdominal surgery or laparoscopy for various types of colorectal resection have shown no effect of chewing gum on postoperative first flatulence and time to defecation, has no significant effect in reducing the average hospital stay and has no significant effect in preventing postoperative nausea, vomiting, or bloating.

One possible reason for the inconsistent results of sham feeding using chewing gum to reduce the incidence of postoperative ileus may be differences in underlying colorectal cancer types and heterogeneity between surgical and postoperative care methods.

Although many studies have been conducted to examine the effectiveness of chewing gum in patients undergoing colorectal resection, the results have been inconsistent. This can be attributed to differences in intestinal injuries affecting bowel function, differences in time under anesthesia differences in anesthetics or pain control agents used for pain control affecting bowel function, and recovery time of peristalsis. Given the many factors known to affect postoperative ileus, chewing gum as an intervention remains a safe, accessible, and inexpensive option that remains to be explored. This study will provide empirical evidence that contributes to a body of literature supporting gum administration for affecting postoperative nausea, flatulence, and stool output in a well-defined sample.

Many interventions and strategies have been used to manage postoperative ileus, such as prokinetic agents and epidural anesthesia. However, these methods have limited efficacy and still have a relatively high incidence of postoperative ileus. Alternatively, chewing gum promotes gastrointestinal peristalsis in post-surgery patients without the adverse effects associated with early feeding. However, results in studies investigating the effect of chewing gum on postoperative recovery of gastrointestinal function after colorectal surgery are conflicting.

Study Type

Interventional

Enrollment (Estimated)

76

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Locations

  • Turkey
      • Adana, Turkey
        • Recruiting
        • Cukurova University
        • Contact:
          • Cukurova University

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria: Being over 18 years old,

  • To have applied for elective colorectal surgery,
  • Having undergone laparoscopic colorectal surgery,
  • Not having a nasogastric insertion,
  • Not having a vision-hearing problem,
  • ECOG performance score to be between 0-2,

Exclusion Criteria:

  • Performing emergency surgical intervention,
  • Open colorectal surgery
  • Need for intensive care after surgery,
  • Stoma has been opened

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Quadruple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: gum chewing

All participants will receive standard postoperative care, 2 L/min of oxygen delivered via nasal cannula if oxygen saturation is below 95%. In addition, participants will be encouraged to use the incentive spirometer 10 times per hour to prevent respiratory complications such as pneumonia. In the postoperative period, all participants will be removed from bed and mobilized as soon as possible.

For the patients in the experimental group, sugar-free xylitol gum containing 1.2-1.37 grams of xylitol per piece, available in the market, will be used. Participants in the experimental group will start chewing gum on the first postoperative day and will be allowed to chew a single piece of gum 3 times a day at 9:00, 14:00 and 19:00, respectively, for 15 minutes. The gum will be given to the participants regularly by a researcher until the first reported flatulence.
Other: gum chewing
For the patients in the experimental group, sugar-free xylitol gum containing 1.2-1.37 grams of xylitol per piece, available in the market, will be used. Participants in the experimental group will start chewing gum on the first postoperative day and will be allowed to chew a single piece of gum 3 times a day at 9:00, 14:00 and 19:00, respectively, for 15 minutes. The gum will be given to the participants regularly by a researcher until the first reported flatulence.
No Intervention: control group

All participants will receive standard postoperative care, 2 L/min of oxygen delivered via nasal cannula if oxygen saturation is below 95%. In addition, participants will be encouraged to use the incentive spirometer 10 times per hour to prevent respiratory complications such as pneumonia. In the postoperative period, all participants will be removed from bed and mobilized as soon as possible.

The control group will receive only standard care.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
prevention of postoperative ileus
Time Frame: 72 hours
The first postoperative gas removal time and the first postoperative stool removal time will be questioned by the researcher. There is no standard scale for this.
72 hours
Prevention of nausea-vomiting.
Time Frame: 72 saat
Nausea and Vomiting Evaluation Form. In our study, PONV status will be evaluated as "Yes/No" at 0, 2, 4, 8, 12 and 24 hours using the Nausea and Vomiting Evaluation Form.
72 saat

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Cukurova University

Collaborators

Tarsus University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 10, 2024

Primary Completion (Estimated)

June 1, 2025

Study Completion (Estimated)

June 1, 2025

Study Registration Dates

First Submitted

August 28, 2023

First Submitted That Met QC Criteria

September 1, 2023

First Posted (Actual)

September 8, 2023

Study Record Updates

Last Update Posted (Estimated)

March 5, 2024

Last Update Submitted That Met QC Criteria

March 2, 2024

Last Verified

March 1, 2024

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CRC (NINDS)

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Results on the effects of chewing gum on nausea, vomiting and bowel functions after colorectal surgery will be shared. However, personal information will not be shared.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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