Dietary interventions to reduce postoperative ileus: coffee and chewing gum
- International Journal of Complementary & Alternative Medicine
Nahima Miah, Sanjay Noonan, Emma Copeland, Eastern Road, Elaine Macaninch
Background and aims: Postoperative ileus (POI) isa common complication after gastrointestinal (GI) surgery requiring parenteral nutrition (PN), with an average length of hospital stay (LHS) of 8.5days per patient at Brighton and Sussex University Hospital (BSUH). Chewing gum (CG) and coffee are cheap and easily accessible and could be used in postoperative care to reduce the rates of POI. The use of CG as a postoperative treatment is also advocated in the Enhanced Recovery after Surgery (ERAS) guidelines. This review aims to determine the efficacy of coffee and CG on reducing POI and investigate their impact upon: LHS, the need for PN, financial outcomes, and safety/efficacy in postoperative management.
Methods: A literature search of randomised controlled trials (RCTs) was performed to identify studies concerning POI, and coffee and CG respectively. Studies dated between January 2008 to December 2018 were obtained from MEDLINE, EMBASE, NICE evidence and TRIP; grey literature sources were also reviewed. Primary outcomes included: time to first flatus, time to first defecation and LHS. Safety, cost effectiveness and the development of complications were also examined.
Results: CG studies (n=10) and coffee studies (n=3) were identified and showed an overall reduction in the development of POI as shown by significant reductions in the time to first flatus and time to first defecation (p<0.05). For LHS, almost half of the included CG studies (n=3) found this to be significantly lower than the control arm (p<0.05), whilst one coffee study found LHS to be significantly lower when compared to tea (p<0.01). Complications were not common or serious and occurred mainly as a result of the surgical intervention rather than from CG or coffee.
Conclusions: This novel review showed CG and coffee to be safe, inexpensive interventions that decrease the incidence of POI and LHS. These findings strengthen the evidence base advocating for the use of CG postoperative –as per the ERAS guideline recommendations. Limitations include the number of studies included, their heterogeneity and their overall quality. However, despite these limitations, this review indicates that further, robust clinical evaluation of this topic would be warranted to clearly establish whether these cheap, conservative measures could be utilised to improve current clinical practices and enable better outcomes for patients.
coffee, chewing gum, POI, GI surgery, LHS, systematic review, ERAS, BSUH, brighton and sussex university hospital, CASP, critical appraisal skills programme, CG, chewing gum, CRBT, cochrane risk of bias tool, CRP, C-reactive protein, ERAS, enhanced recovery After Surgery, ESPEN, european society for clinical nutrition and metabolism, GI, gastrointestinal, LHS, length of stay, MeSH, medical subject headings, PN, parenteral nutrition, POI, postoperative ileus, RCT, randomised control trial, SC, standard care, TTFD, time to first defecation, TTFF, time to first flatus