Tuesday, February 14, 2006

Chewing gum -- A good habit in the hospital?

If you are going to have a colon resection some time in the near future, it may be a good idea to take a few packs of gum to the hospital along with your toothbrush and books. An article in February's Archives of Surgery shows that gum chewing appears to speed the return of bowel function after elective colectomy. The article, entitled "Gum Chewing Reduces Ileus After Elective Open Sigmoid Colectomy," is from the Santa Barbara Cottage Hospital; the abstract is not yet available on-line, but will be here soon.

A total of 34 patients were randomized into 2 groups: a gum-chewing group (n=17) or a control group (n=17). The patients in the gum-chewing group chewed sugarless gum 3 times daily for 1 hour each time until discharge....The passage of flatus occurred on postoperative hour 65.4 in the gum-chewing group and on hour 80.2 in the control group (P=.05). The first bowel movement occurred on postoperative hour 63.2 in the gum-chewing group and on hour 89.4 in the control group (P=.04)....The total length of hospital stay was shorter in the gum-chewing group (day 4.3) than in the control group (day 6.8), (P=.01).
A considerable amount of research has gone into the issue of postoperative ileus, including pharmacological stimulation and sham feeding (wouldn't that just tick you off!). There have been many proponents of early feeding, but many surgeons, including myself, have found that most patients do not tolerate it well. Gum chewing may be a more palatable and easy to implement alternative to sham feeding -- the mechanism of action of sham feeding and gum chewing is presumed to be stimulation of the cephalic-vagal system, resulting in increased levels of neural and humoral hormones that stimulate bowel motility in the GI tract.
An added bonus? It's cheap! While gum chewing may not be a great option for patients with a prolonged ileus, it may be a pleasant way for many patients to shorten their hospital stay. Unfortunately, the gum we provide may not be quite as enticing as Willy Wonka's:

Willy Wonka: Don't you know what this is?
Violet Beauregarde: By gum, it's gum.
Willy Wonka: Wrong. It's the most fabulous sensational gum in the whole world.
Violet Beauregarde: What's so fab about it?
Willy Wonka: This little piece of gum is a three course dinner.
Mr. Salt: Bull.
Willy Wonka: No, roast beef. But I haven't got it quite right yet.

Please, just don't leave your old pieces stuck to the underside of the bed control.