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. 2023 Aug;27(8):1730-1745.
doi: 10.1007/s11605-023-05702-z. Epub 2023 Jun 5.

Gum Chewing and Coffee Consumption but not Caffeine Intake Improve Bowel Function after Gastrointestinal Surgery: a Systematic Review and Network Meta-analysis

Stefanie Sinz  1   2 , René Warschkow  1 , Ignazio Tarantino  1 , Thomas Steffen  3
Affiliations

Gum Chewing and Coffee Consumption but not Caffeine Intake Improve Bowel Function after Gastrointestinal Surgery: a Systematic Review and Network Meta-analysis

Stefanie Sinz et al. J Gastrointest Surg. 2023 Aug.

Abstract

Background: Postoperative ileus is common after gastrointestinal surgery. This network meta-analysis aimed to compare the effectiveness of gum chewing and coffee and caffeine intake on ileus-related outcomes.

Methods: A systematic literature review was performed to identify randomized controlled trials (RCTs) comparing noninvasive treatments for ileus after gastrointestinal surgery. The main analyses included random effects network meta-analyses using frequentist methods with simultaneous direct and indirect comparisons of time to first flatus, time to first defecation, and length of stay. Bayesian network meta-analysis using Markov chains was also used.

Results: A total of 32 RCTs comparing 4999 patients were included in this network meta-analysis. Time to flatus was reduced by gum chewing (mean difference compared to control (MD): -11 h, 95% confidence interval (95% CI) - 16 to - 5 h, P < 0.001). Time to defecation was reduced by gum chewing and coffee, with MDs of -18 h (95% CI - 23 to - 13 h, P < 0.001) and -13 h (95% CI - 24 to - 1 h, P < 0.001), respectively. Length of stay was reduced by coffee and gum chewing with MDs of - 1.5 days (95% CI: - 2.5 to - 0.6 days, P < 0.001) and - 0.9 days (95% CI: - 1.3 to - 0.4 days, P < 0.001), respectively.

Conclusion: Coffee and gum chewing were proven to be effective noninvasive approaches for shortening the postoperative length of hospital stay and time to first defecation, especially in open gastrointestinal surgery; thus these actions should be recommended after gastrointestinal surgery.

Keywords: Abdominal surgery; Bowel function; Bowel surgery; Caffeine; Coffee; Gastrointestinal surgery; Gum chewing; Network meta-analysis; Postoperative ileus; Systematic review.

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Conflict of interest statement

The authors report no conflicts of interest. TS holds a grant from the “Stiftung Chirurgie,” St. Gallen, Switzerland, to financially support scientific publications in surgery.

Figures

Fig. 1
Fig. 1
PRISMA flow chart showing the selection of articles for review
Fig. 2
Fig. 2
Forest plot for univariable random-effects meta-analyses of the mean difference in pairwise comparisons against control for time to first flatus (A), time to first defecation (B), and length of hospital stay (C)
Fig. 2
Fig. 2
Forest plot for univariable random-effects meta-analyses of the mean difference in pairwise comparisons against control for time to first flatus (A), time to first defecation (B), and length of hospital stay (C)
Fig. 2
Fig. 2
Forest plot for univariable random-effects meta-analyses of the mean difference in pairwise comparisons against control for time to first flatus (A), time to first defecation (B), and length of hospital stay (C)
Fig. 3
Fig. 3
Summary plot for point estimates and their corresponding 95% confidence and credible intervals in the frequentist and Bayesian network meta-analyses
Fig. 4
Fig. 4
Subgroup analysis for point estimates and their corresponding 95% confidence and credible intervals in random effects and Bayesian network meta-analysis in laparoscopic (A) and open (B) gastrointestinal surgery
Fig. 4
Fig. 4
Subgroup analysis for point estimates and their corresponding 95% confidence and credible intervals in random effects and Bayesian network meta-analysis in laparoscopic (A) and open (B) gastrointestinal surgery
See this image and copyright information in PMC

Comment in

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