Efficacy of chewing gum in post-cesarean ileus: A randomized clinical trial
DOI:
https://doi.org/10.5281/zenodo.14200085Keywords:
Chewing Gum, Cesarean Section, Postoperative Period, Gastrointestinal Motility, Intestinal Pseudo-ObstructionAbstract
Background: The use of chewing gum postoperatively has been shown to be useful in the recovery of postoperative ileus.
Objective: To evaluate the efficacy of using chewing gum as simulated feeding for the recovery of postoperative ileus after cesarean section.
Material and methods: Randomized, controlled, double-blind clinical trial in women ≥ 18 years, during the postoperative period of cesarean section, distributed in 2 groups, group A (chewing gum, n = 63) and group B (control, n = 63). The postoperative time elapsed until the first flatus, the presence of evacuation during the postoperative period before hospital discharge, and the time elapsed until the first postoperative evacuation and length of hospital stay (HS) were evaluated.
Results: 126 patients were included. Postoperative evacuation before hospital discharge was more frequent in group A (p = 0.01); in addition, there was a shorter length of HS (p = 0.04); no patient presented nausea during the postoperative period (p = 0.0001). No difference was observed between the study groups regarding the time to onset of first flatus (p = 0.17), or the time elapsed to first postoperative evacuation (p = 0.07). The number needed to treat (NNT) was 5 and the absolute risk reduction (ARR) was 21%, for both the presence of nausea and the absence of postoperative evacuation. No patient reported complications.
Conclusions: The use of chewing gum as simulated feeding after cesarean section is effective and safe for recovery from postoperative ileus.
Downloads
References
Martínez-Salazar GJ, Grimaldo-Valenzuela PM, Vázquez-Peña GG, et al. Operación cesárea. Una visión histórica, epidemiológica y ética para disminuir su incidencia. Rev Med Inst Mex Seguro Soc. 2015;53(5):608-15. Disponible en: http://revistamedica.imss.gob.mx/editorial/index.php/revista_medica/article/view/168/436
Lomelí-Muñoz Márquez EM, Piña-Cancino S, Carranza-Lira S. Características clínicas y de laboratorio en pacientes ginecológicas y obstétricas con infección de sitio quirúrgico. Rev Med Inst Mex Seguro Soc. 2020;58(2):137-44. Disponible en: http://revistamedica.imss.gob.mx/editorial/index.php/revista_medica/article/view/3283/3924
Guía de Práctica Clínica para la Reducción de la Frecuencia de Operación Cesárea. México: Instituto Mexicano de Seguro Social; 2014. Disponible en: https://www.imss.gob.mx/sites/all/statics/guiasclinicas/048GER.pdf
Hellstrom EA, Ziegler AL, Blikslager AT. Postoperative Ileus: Comparative Pathophysiology and Future Therapies. Front Vet Sci. 2021;8:714800. doi: 10.3389/fvets.2021.714800
Zlakishvili B, Sela HY, Tankel J, et al. Post-cesarean ileus: An assessment of incidence, risk factors and outcomes. Eur J Obstet Gynecol Reprod Biol. 2022;269:55-61. doi: 10.1016/j.ejogrb.2021.12.019
Bollag L, Lim G, Sultan P, et al. Society for Obstetric Anesthesia and Perinatology: Consensus Statement and Recommendations for Enhanced Recovery After Cesarean. Anesth Analg. 2021;132(5):1362-77. doi: 10.1213/ANE.0000000000005257
Roslan F, Kushairi A, Cappuyns L, et al. The Impact of Sham Feeding with Chewing Gum on Postoperative Ileus Following Colorectal Surgery: a Meta-Analysis of Randomised Controlled Trials. J Gastrointest Surg. 2020;24(11):2643-53. doi: 10.1007/s11605-019-04507-3
Altraigey A, Ellaithy M, Atia H, et al. The effect of gum chewing on the return of bowel motility after planned cesarean delivery: a randomized controlled trial. J Matern Fetal Neonatal Med. 2020;33(10):1670-7. doi: 10.1080/14767058.2018.1526913
Yenigul NN, Aydogan Mathyk B, Aslan Cetin B, et al. Efficacy of chewing gum for improving bowel function after cesarean sections: a randomized controlled trial. J Matern Fetal Neonatal Med. 2020;33(11):1840-5. doi: 10.1080/14767058.2018.1531122
Berghella V, Saccone G, Ciardulli A, et al. Reply to letter to the editor regarding the article: chewing gum improves postoperative recovery of gastrointestinal function after cesarean delivery: a systematic review and meta-analysis of randomized trials. J Matern Fetal Neonatal Med. 2020;33(13):2311.doi: 10.1080/14767058.2018.1545389
Tuscharoenporn T, Uruwankul K, Charoenkwan K. Effects of Postoperative Gum Chewing on Recovery of Gastrointestinal Function Following Laparoscopic Gynecologic Surgery: Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med. 2024;13(10):2851. doi: 10.3390/jcm13102851
Lunding JA, Nordström LM, Haukelid AO, et al. Vagal activation by sham feeding improves gastric motility in functional dyspepsia. Neurogastroenterol Motil. 2008;20(6):618-24. doi: 10.1111/j.1365-2982.2007.01076.x
Chibly AM, Aure MH, Patel VN, et al. Salivary gland function, development, and regeneration. Physiol Rev. 2022;102(3):1495-552. doi: 10.1152/physrev.00015.2021
Brundha N, Biradar A, Patil N, et al. Chewing Gum Versus Standard Care for Enhanced Bowel Recovery After Cesarean Section: A Randomized Clinical Trial. Cureus. 2024;16(8):e68210. doi: 10.7759/cureus.68210
Santos DJDS, Jr JC. Chewing gum as a non-pharmacological alternative for orthodontic pain relief: A randomized clinical trial using an intention-to-treat analysis. Korean J Orthod. 2021;51(5):346-54. doi: 10.4041/kjod.2021.51.5.346
Hamel JF, Sabbagh C, Alves A, et al. Comparison of treatment to improve gastrointestinal functions after colorectal surgery within enhanced recovery programmes: a systematic review and meta-analysis. Sci Rep. 2021;11(1):7423. doi: 10.1038/s41598-021-86699-w
Pereira Gomes Morais E, Riera R, Porfírio GJ, et al. Chewing gum for enhancing early recovery of bowel function after caesarean section. Cochrane Database Syst Rev. 2016;10(10):CD011562. doi: 10.1002/14651858.CD011562.pub2
VassarStats: Website for Statistical Computation. Disponible en: http://vassarstats.net/
Ajuzieogu O, Amucheazi A, Ezike H, et al. The efficacy of chewing gum on postoperative ileus following cesarean section in Enugu, South East Nigeria: A randomized controlled clinical trial. Niger J Clin Pract. 2014;17(6):739-42. doi: 10.4103/1119-3077.144388
Liu Q, Jiang H, Xu D, et al. Effect of gum chewing on ameliorating ileus following colorectal surgery: A meta-analysis of 18 randomized controlled trials. Int J Surg. 2017;47:107-15. doi: 10.1016/j.ijsu.2017.07.107
Turkay Ü, Yavuz A, Hortu İ, et al. The impact of chewing gum on postoperative bowel activity and postoperative pain after total laparoscopic hysterectomy. J Obstet Gynaecol. 2020;40(5):705-9. doi: 10.1080/01443615.2019.1652891
Wattchow D, Heitmann P, Smolilo D, et al. Postoperative ileus-An ongoing conundrum. Neurogastroenterol Motil. 2021;33(5):e14046. doi: 10.1111/nmo.14046
Kanza Gül D, Şolt Kırca A. Effects of acupressure, gum chewing and coffee consumption on the gastrointestinal system after caesarean section under spinal anaesthesia. J Obstet Gynaecol. 2021;41(4):573-80. doi: 10.1080/01443615.2020.1787363
Khawaja ZH, Gendia A, Adnan N, et al. Prevention and Management of Postoperative Ileus: A Review of Current Practice. Cureus. 2022;14(2):e22652. doi: 10.7759/cureus.22652
Muhumuza J, Molen SF, Mauricio W, et al. Effect of Chewing Gum on Duration of Postoperative Ileus Following Laparotomy for Gastroduodenal Perforations: Protocol for a Randomized Controlled Trial. Int J Surg Protoc. 2023;27(1):9-17. doi: 10.29337/ijsp.188
Gungorduk K, Ozdemir IA. Non-pharmacological interventions for the prevention of postoperative ileus after gynecologic cancer surgery. Taiwan J Obstet Gynecol. 2021;60(1):9-12. doi: 10.1016/j.tjog.2020.11.002
Bang YJ, Lee EK, Kang R, et al. Effect of chewing gum on anxiety in women undergoing elective cesarean section: a randomized controlled study. Ann Palliat Med. 2023;12(3):529-37. doi: 10.21037/apm-22-811
Berg J, Källén K, Andolf E, et al. Economic Evaluation of Elective Cesarean Section on Maternal Request Compared With Planned Vaginal Birth-Application to Swedish Setting Using National Registry Data. Value Health. 2023;26(5):639-48. doi: 10.1016/j.jval.2022.10.003
Published
Issue
Section
License
Copyright (c) 2025 Revista Médica del Instituto Mexicano del Seguro Social
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors retain their copyright and grant the Revista Médica del IMSS the right of first publication. Articles are distributed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which allows sharing as long as the author and the original source are properly credited.
