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

NCT06029790 | Completed

• 1 other identifier: CRC
• Study Type: interventional
• Target: 84
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Postsurgical Ileus

Keywords

postsurgical ileus; chewing gum; colorectal surgery

Outcome Measures

Primary Outcomes (2)

• prevention of postoperative ileus

  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.

  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

Study Arms (2)

gum chewing

EXPERIMENTAL

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

control group

NO INTERVENTION

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.

Interventions

gum chewing OTHER

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.

gum chewing

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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,

You may not qualify if:

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

Sponsors & Collaborators

• Cukurova University: lead
• Tarsus University: collaborator

Study Sites (1)

Cukurova University

Adana, Turkey (Türkiye)

Location

Related Publications (12)

• van den Heijkant TC, Costes LM, van der Lee DG, Aerts B, Osinga-de Jong M, Rutten HR, Hulsewe KW, de Jonge WJ, Buurman WA, Luyer MD. Randomized clinical trial of the effect of gum chewing on postoperative ileus and inflammation in colorectal surgery. Br J Surg. 2015 Feb;102(3):202-11. doi: 10.1002/bjs.9691. Epub 2014 Dec 18.

  PMID: 25524125 BACKGROUND

• Yang P, Long WJ, Wei L. Chewing Xylitol Gum could Accelerate Bowel motility Recovery after Elective Open Proctectomy for Rectal Cancer. Rev Invest Clin. 2018;70(1):53-58. doi: 10.24875/RIC.18002428.

  PMID: 29513303 BACKGROUND

• Liu Q, Jiang H, Xu D, Jin J. Effect of gum chewing on ameliorating ileus following colorectal surgery: A meta-analysis of 18 randomized controlled trials. Int J Surg. 2017 Nov;47:107-115. doi: 10.1016/j.ijsu.2017.07.107. Epub 2017 Sep 1.

  PMID: 28867465 BACKGROUND

• Hsu YC, Szu SY. Effects of Gum Chewing on Recovery From Postoperative Ileus: A Randomized Clinical Trail. J Nurs Res. 2022 Oct 1;30(5):e233. doi: 10.1097/jnr.0000000000000510.

  PMID: 35951432 BACKGROUND

• Lee JT, Hsieh MH, Cheng PJ, Lin JR. The Role of Xylitol Gum Chewing in Restoring Postoperative Bowel Activity After Cesarean Section. Biol Res Nurs. 2016 Mar;18(2):167-72. doi: 10.1177/1099800415592966. Epub 2015 Jul 7.

  PMID: 26156002 BACKGROUND

• Forrester DA, Doyle-Munoz J, McTigue T, D'Andrea S, Natale-Ryan A. The efficacy of gum chewing in reducing postoperative ileus: a multisite randomized controlled trial. J Wound Ostomy Continence Nurs. 2014 May-Jun;41(3):227-32. doi: 10.1097/WON.0000000000000019.

  PMID: 24621587 BACKGROUND

• Kobayashi T, Masaki T, Kogawa K, Matsuoka H, Sugiyama M. Efficacy of Gum Chewing on Bowel Movement After Open Colectomy for Left-Sided Colorectal Cancer: A Randomized Clinical Trial. Dis Colon Rectum. 2015 Nov;58(11):1058-63. doi: 10.1097/DCR.0000000000000452.

  PMID: 26445178 BACKGROUND

• Suh SY, Leblanc TW, Shelby RA, Samsa GP, Abernethy AP. Longitudinal patient-reported performance status assessment in the cancer clinic is feasible and prognostic. J Oncol Pract. 2011 Nov;7(6):374-81. doi: 10.1200/JOP.2011.000434.

  PMID: 22379420 BACKGROUND

• Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982 Dec;5(6):649-55. No abstract available.

  PMID: 7165009 BACKGROUND

• Apfel CC, Laara E, Koivuranta M, Greim CA, Roewer N. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers. Anesthesiology. 1999 Sep;91(3):693-700. doi: 10.1097/00000542-199909000-00022.

  PMID: 10485781 BACKGROUND

• Gustafsson UO, Scott MJ, Hubner M, Nygren J, Demartines N, Francis N, Rockall TA, Young-Fadok TM, Hill AG, Soop M, de Boer HD, Urman RD, Chang GJ, Fichera A, Kessler H, Grass F, Whang EE, Fawcett WJ, Carli F, Lobo DN, Rollins KE, Balfour A, Baldini G, Riedel B, Ljungqvist O. Guidelines for Perioperative Care in Elective Colorectal Surgery: Enhanced Recovery After Surgery (ERAS(R)) Society Recommendations: 2018. World J Surg. 2019 Mar;43(3):659-695. doi: 10.1007/s00268-018-4844-y.

  PMID: 30426190 BACKGROUND

• Gezer D, Alptekin D, Yalav O, Eray IC. Effect of gum chewing on the return of bowel sounds, time to first flatus, and defecation after colorectal cancer surgery: A prospective, randomized controlled trial. Eur J Oncol Nurs. 2025 Dec;79:103039. doi: 10.1016/j.ejon.2025.103039. Epub 2025 Nov 7.

  PMID: 41232231 DERIVED

Related Links

• Chewing gum for postoperative ileus after colorectal surgery: A systematic review of overlapping meta-analyses

MeSH Terms

Interventions

Chewing Gum

Intervention Hierarchy (Ancestors)

Plant Gums; Biopolymers; Polymers; Macromolecular Substances; Polysaccharides; Carbohydrates; Plant Exudates; Biological Products; Complex Mixtures; Candy; Food; Diet, Food, and Nutrition; Physiological Phenomena; Food and Beverages

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: QUADRUPLE
• Who Masked: PARTICIPANT, CARE PROVIDER, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Profesor

Model Details: The study was planned as a prospective, single-blind, parallel-group, randomized controlled study.

Study Record Dates

• First Submitted: August 28, 2023
• First Posted: September 8, 2023
• Study Start: January 10, 2024
• Primary Completion: June 20, 2024
• Study Completion: August 19, 2024
• Last Updated: March 16, 2026

Record last verified: 2026-03

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)