Motahare Pilevarzadeh

Instructor of Nursing, School of Nursing and Midwifery, Jiroft University of Medical Sciences, Jiroft, Iran.   Corresponding author Email: mo.mp12@yahoo.com

DOI : https://dx.doi.org/10.13005/bpj/952

Abstract

Paralytic ileus after abdominal surgery causes abdominal distention, pain, accumulation of gas, nausea and vomiting. Chewing gum can increase bowel movements and reduce the transient period of paralysis. The purpose of this study was to determine the effect of gum chewing in the reduction of paralytic ileus following cholecystectomy. This interventional study was conducted on 40 patients undergoing cholecystectomy  in Jiroft University of Medical Sciences, 2012. After surgery, they were randomly allocated to intervention (gum chewing) and control groups. Patients in the intervention group chewed sugar free gum 3 times a day for an hour each time after full consciousness. The first bowel sounds, flatus passage and defecation were recorded in both groups. Data were analyzed using student T-test. The first gas passing was reported 21.05±12.8  and 40.8±15.9 hours following operation in intervention and control groups, respectively. The first defection was occurred 38.1±29.8 and58.25±18.6 hours after operation in intervention and control groups, respectively. The first bowel sounds were heard 4±1.02 and 4.9±1.3 hours post-operatively in intervention and control groups, respectively. In all three cases, the difference between two groups was statistically significant. With regard to the results, gum chewing is an inexpensive and useful approach that reduces paralytic  ileus  following  cholecystectomy.

Keywords

Ileus; Cholecystectomy; Chewing Gum

Download this article as: 

Copy the following to cite this article: Pilevarzadeh M. Effect of Gum Chewing in the Reduction of Paralytic Ileus Following Cholecystectomy. Biomed Pharmacol J 2016;9(1)

Copy the following to cite this URL: Pilevarzadeh M. Effect of Gum Chewing in the Reduction of Paralytic Ileus Following Cholecystectomy. Biomed Pharmacol J 2015;9(1). Available from: http://biomedpharmajournal.org/?p=7137

Introduction

Paralytic ileus is a basic disruption emerging after abdominal surgery and is defined as the delayed return of the coordinated intestinal motility. This disruption makes the improvement delayed and increases the hospital days of stay. The economic effects of this disruption are estimated as equal to 750 million to 1 billion USD in America. Apart from the economic issues, the patient’s lack of comfortableness and other problems such as the hospital infections are very important ^(1-3). After most surgeries, the activity of the bowels is inhibited and this causes abdominal distention, accumulation of gas, nausea and vomiting. Longer and wider abdominal surgery leads to more severity of this disruption ⁽⁴⁾. Postoperative ileus occurs due to the reduction of intestinal activity and the lack of the activity of parasympathetic nervous system ⁽⁵⁾. Up to now, several methods have been studied for the reduction of the Postoperative ileus period among which one can refer to use epidural anesthesia, the reduction of using narcotic perfusion by prescribing non-steroidal anti-inflammatory drugs (NSAIDS), laparoscopic surgery, and using high-carbohydrate drinks after the surgery ^(6-7). One of the methods that have been recently noted by some researchers for reducing paralytic ileus is gum chewing. Gum chewing is a sort of fake feed stimulating the digestion. This in turn causes the increase of the gastrin   plasma concentration and pancreatic polypeptide and increases the duodenal alkali discharge and it can be effective on the reduction of paralytic ileus duration ^(9-10).

The researches by Fitzgerald et al, Chan et al, and Marwah et al ^(10-12) showed the effects of gum chewing on the reduction of paralytic ileus. But Matros et al. and Quah et al ^(13-14) failed to demonstrate the useful effect of the gum chewing after some surgeries. Thus it seems there is a disagreement between the researchers’ findings. This research aims to study the effects of the gum chewing on the improvement of ileus after cholecystectomy surgery.

Methods and Materials

This interventional study (based on the ethical code of K/90/135) was confirmed by the Ethical Regional Committee in the Research Center of Iranian Kerman University of Medical Sciences. Then it was conducted on 40 volunteer patients undergoing cholecystectomy surgery in Imam Khomeini Hospital of Jiroft in 2012. The patients were randomly classified into two groups: intervention group (gum chewer) with 24 subjects, and control group with 26 subjects.

The subjects of the both groups were matched regarding the variables of the age and gender. The including criteria were the age +15 and the Cholecystectomy surgery in laparotomy method; and the excluding criteria were the diabetes record, abdominal surgery experience, hypothyroidism, electrolyte disorders, neuromuscular suffering, drug addiction, having dentures, and need for being hospitalized in ICU.

The patients of the both groups were anesthetized in similar method and were operated by the same surgeon.  This research was conducted after informing the patients about the objectives and methods of the research and all patients participated in it voluntarily.  Patients in the intervention group chewed sugar free gum (Orbit brand produced by Wrigley Company) 3 times a day for 20 minutes each time after full consciousness until the beginning of the oral intake. The bowel sounds of the both groups were recorded by a partner practitioner using stethoscope each 2 hours, and the time of the flatus passage and defecation of the both groups were recorded on the assessment form by a trained nurse. The practitioner and the nurse were not informed about the intervention and control groups. The collected data were analyzed using SPSS 15 and statistical t-test. The accepted significance level was considered as lower than 0.05.

The age average of the intervention group was equal to 56.6±13.9 and the corresponding age average of the control group was equal to 56.2±15.7. There was no significant difference between the two groups of patients with regard to their age, gender, and educational level (Table 1).

Table 1: Gender and educational level of the two groups of patients

Group		Intervention		Control
Variable		Number	Percent	Number	Percent
Gender	Male	12	50	14	45
	Female	12	50	12	55
Educational level	Illiterate	88	33.4	9	34.6
	elementary	5	20.8	8	30.8
	High school	7	29.1	6	23.1
	University	4	16.7	3	11.5

 

The average time of hospital stay in the intervention and control group was equal to 3.1±0.3 and 3.5±0.5 days respectively. The results showed a statistically significant difference between the means of the gas passing duration, the means of the duration of defection, and the means of the first bowel sound after the operation in the two groups of the patients (Table 2).

Table 2. Comparison of the mean of the two groups’ intestinal indexes per hour

Group	Intervention	Control	Sig.
Variable
Gas passing	21.05±12.8	40.8±15.9	P=0.001
Defection	38.1±29.8	58.25±18.6	P=0.002
Bowel sound hearing	4±0.02	1.9±1.2	P=0.096

 

 Conclusion

This research showed that chewing the sugar-free gum after cholecystectomy surgery will lead to the decrease of the gas passing, defection, and bowel sound hearing time and indeed to the decrease of the paralytic ileus in the patients. This result is consistent with the results of several relevant studies ^(15-19).

In their research, Purkayastha et al. showed that the return of the time of bowel sounds in the intervention group (gum chewers) occurs significantly sooner in comparison to the control group. This result is consistent with our findings ⁽²⁰⁾.

In another research, Schuster et al. studied the effect of chewing gum in elective open sigmoid colectomy patients on the hearing the first intestinal sounds. They found that the first hearing of the bowel sounds in the intervention group was equal to 89.4 but the same time for the control group was equal to 65.4. Again this finding is consistent with our result ⁽²¹⁾.

As mentioned before, the mean of the first hearing of the gas passing in the intervention and control groups was equal to 21.05±12.8 and 40.8±15.9 respectively; while this difference is significant statistically. This finding is consistent with the results of Ghafouri, et al., and Hirayama, et al; but it is inconsistent with the results of Quah, et al.^{(3, 14, 22)} The shorter time of the intestinal movement returns in the intervention group can be interpreted due to the mechanism of the gum performance ⁽¹²⁾. In our research the mean of the defection time was recorded as sooner than the corresponding time of the control group. This piece of finding is consistent with researches by Hirayama et al. and Kouba et al. ^{(22, 23)}; but it is not consistent with the studies by Matros et al. and Quah, et al^{.(13, 14)}

The results of this research showed that the hospital stay time in the intervention group was lower than the control group. De. Keller D, et al. showed that early feeding after the operation can reduce the duration of the hospital stay ⁽²⁴⁾, (25). Moreover, the obtained results by King et al. and Soop et al. found that the gum chewing decreases the duration of the hospital stay after the surgery. Their results were consistent with our findings in this research ^{(26, 27)}. Additionally, in their research, Vásquez et al. suggested chewing the gum as a standard treatment after the abdominal surgery ⁽²⁸⁾. By and large, gum chewing will lead to the reduction of paralytic ileus following cholecystectomy and it can be used as inexpensive and useful method for the bowel stimulation.

Acknowledgment

We are willing to thank the patients who participated in this research, and the Physiological Research Center of Kerman University of Medical Sciences for approving this proposal and for their cooperation in conducting this research.

References

1. Maldini B, Novotny Z, Letica-Brnadić R et al. Difficult airway management with bonfils fiberscope in case of emergency: acute abdomen with ileus. Acta Clin Croat 2012 Sep; 51 (3): 483-7.
2. Kinoshita Y, Saitoh T, Ishihara S. Paralytic illus. Nihon Rinsho 2012 Aug; 70 (Suppl 6): 557-60.
3. Ghafouri A, Soroush AR, Moini N, et al. The efficacy of sugar free gum chewing after upper GI tract operation on ileus: a clinical trial. Iranian J Surgery. 2008; 16 (1): 79-84.
4. Rafati S, Mashayekhi F, Rafati F, Ezati Rad R, Pilevarzadeh M. Factors Associated With Cesarean Section Selection Among Pregnant Women Runing Head: Cesarean Section. Journal of Current Research in Sciences. 2014, Vol. 2, No. 6, pp: 938-942.
5. 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. 2012 Mar-Apr;18(2):111-7.
6. Napolitano L, Waku M, De Nicola P, et al. Laparoscopic colectomy in colon cancer. A single-center clinical experience. G Chir 2007 Apr; 28 (4): 126-33.
7. Gustafsson UO, Hausel J, Thorell A, Ljungqvist O, Soop M, Nygren J .Adherence to the enhanced recovery after surgery protocol and outcomes after colorectal cancer surgery. Arch Surg. 2011 May;146(5):571-7 .
8. Hwang DY, Kim HY, Kim JH, Lee IG, Kim JK, Oh ST, Lee YS . Effect of gum chewing on the recovery from laparoscopic colorectal cancer surgery. Ann Coloproctol. 2013 Dec;29(6):248-51
9. Lunding JA, Nordström LM, Haukelid AO, et al. Vagal activation by sham feeding improves gastric motility in functional dyspepsia. Neurogastroenterol Motil 2008 Jun; 20 (6): 618-24.
10. 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 2009 Dec; 33 (12): 2557-66.
11. Chan MK, Law WL. Use of chewing gum in reducing postoperative illus after elective colorectal resection: a systematic review. Dis Colon Rectum 2007 Dec; 50 (12): 2149-57.
12. Marwah S, Singla Sh, 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. 2012 Mar-Apr; 18 (2): 111-17.
13. Matros E, Rocha F, Zinner M, et al. Does gum chewing ameliorate postoperative ileus? Results of a prospective, randomized, placebo-controlled trial. J Am Coll Surg 2006 May; 202 (5): 773-8.
14. Quah HM, Samad A, Neathey AJ, et al. Does gum chewing reduce postoperative illus following open colectomy for left-sided colon and rectal cancer? A prospective randomized controlled trial. Colorectal Dis 2006 Jan; 8 (1): 64-70.
15. Yin Z, Sun J, Liu T, et al. Gum chewing: another simple potential method for more rapid improvement of postoperative gastrointestinal function. Digestion 2013; 87 (2): 67-74.
16. Shang H, Yang Y, Tong X, Zhang L, Fang A, Hong. Gum chewing slightly enhances early recovery from postoperative ileus after cesarean section: results of a prospective, randomized, controlled trial. Am J Perinatol. 2010 May;27(5):387-91.
17. Abd-El-Maeboud KH, Ibrahim MI, Shalaby DA, Fikry MF. Gum chewing stimulates early return of bowel motility after caesarean section. BJOG 2009 Sep; 116 (10): 1334-9.
18. 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 2009 May; 24 (5): 585-92.
19. Noble EJ, Harris R, Hosie KB, et al. Gum chewing reduces postoperative ileus? A systematic review and meta-analysis. Int J Surg 2009 Apr; 7 (2): 100-5.
20. Purkayastha S, Tilney HS, Darzi AW, Tekkis PP. Meta-analysis of randomized studies evaluating chewing gum to enhance postoperative recovery following colectomy. Arch Surg 2008 Aug; 143 (8): 788-93.
21. Schuster R, Grewal N, Greaney GC, Waxman K. Gum chewing reduces ileus after elective Open sigmoid colectomy. Arch Surg 2006 Feb; 141 (2): 174-6.
22. Hirayama I, Suzuki M, Ide M, et al. Gumchewing stimulates bowel motility after surgery for colorectal cancer. Hepatogastroenterology 2006 Mar-Apr; 53 (68): 206-8.
23. Kouba EJ, Wallen EM, Pruthi RS. Gum chewing stimulates bowel motility in patients undergoing radical cystectomy with urinary diversion. Urology 2007 Dec; 70 (6): 1053-6.
24. Keller D, Stein SL .Facilitating return of bowel function after colorectal surgery: Alvimopan and gum chewing. Clin Colon Rectal Surg. 2013 Sep;26(3):186-190.
25. Pilevarzadeh M, Hossien Rezai H, Salari S. The effect of exercise on post cesarean section pain. The Journal of Qazvin Univ of Med Sci. 2003; 28: 54-57.
26. Yin Z, Sun J, Liu T, Zhu Y, Peng S, Wang J .Gum chewing: another simple potential method for more rapid improvement of postoperative gastrointestinal function. Digestion. 2013;87(2):67-74.
27. Soop M, Nygren J, Ljungqvist O.Optimizing perioperative management of Patients undergoing colorectal surgery: what is new? Curr Opin Crit Care 2006 Apr; 12 (2): 166-70.
28. Vásquez W, Hernández AV, Garcia- Sabrido JL. Is gum chewing useful for ileus after elective colorectal surgery? A systematic review and meta-analysis of randomized clinical J Gastrointest Surg 2009: Apr; 13 (4): 649-56.