Author: A. LN, et al.
Cureus, April 2026
Postoperative ileus is a frequent complication following abdominal surgery. Delayed gastrointestinal recovery can cause abdominal distention, discomfort, nausea, vomiting, delayed oral intake, and prolonged hospitalization.
Chewing gum has been proposed as a simple form of “sham feeding.” Although the patient does not swallow food, chewing stimulates cephalic-vagal pathways, gastrointestinal hormones, salivation, and digestive activity that may promote bowel motility.
This randomized controlled study evaluated whether postoperative chewing gum could accelerate the return of gastrointestinal function following elective abdominal surgery.
Methods
The single-blinded study included 198 adult patients undergoing elective abdominal surgery.
Patients were randomly divided into two equal groups:
• Chewing gum group: 99 patients
• Standard-care control group: 99 patients
Patients assigned to the intervention group received chewing gum once they were fully awake following anesthesia and had intact protective airway reflexes.
The control group received routine postoperative care without chewing gum.
The groups had similar demographic characteristics, surgical procedures, and baseline risk factors.
Primary outcomes
The primary outcomes were:
• Time to passage of the first flatus
• Time to appearance of the first bowel sounds
Secondary outcomes included:
• Incidence and duration of postoperative nausea and vomiting
• Time to complete resolution of nausea and vomiting
• Length of hospital stay
• Adverse effects related to chewing gum
First passage of flatus
Patients who chewed gum passed flatus substantially earlier than patients receiving standard care.
The average time to first flatus was:
• Chewing gum group: 197 minutes
• Control group: 280 minutes
This represented an improvement of approximately 83 minutes and was highly statistically significant.
The earlier passage of flatus suggested that chewing gum accelerated the recovery of postoperative intestinal motility.
Return of bowel sounds
The first postoperative bowel sounds also appeared significantly earlier in patients who received chewing gum.
The average time to the first bowel sounds was:
• Chewing gum group: 201.5 minutes
• Control group: 280 minutes
This represented an improvement of approximately 78.5 minutes.
The benefit was observed across different surgical approaches and among both male and female patients.
Postoperative nausea and vomiting
Chewing gum was also associated with a lower incidence and shorter duration of postoperative nausea and vomiting.
Complete resolution of nausea and vomiting occurred at an average of:
• Chewing gum group: 126 minutes
• Control group: 237.5 minutes
Patients chewing gum therefore experienced complete relief approximately 111 minutes sooner than patients receiving standard care.
The reduction in postoperative nausea and vomiting may result from improved gastric emptying, increased gastrointestinal motility, enhanced salivation, and decreased intestinal distention.
Length of hospital stay
Patients in the chewing gum group had significantly shorter hospital stays.
The average hospitalization was:
• Chewing gum group: 1.7 days
• Control group: 3.1 days
This represented an average reduction of approximately 1.4 hospital days.
Although discharge timing can be affected by factors beyond gastrointestinal recovery, the substantial difference suggests that earlier bowel function may contribute to faster overall postoperative recovery.
Independent effect of chewing gum
Multivariable statistical analysis was used to account for other factors that could affect gastrointestinal recovery.
Chewing gum remained an independent predictor of earlier gastrointestinal recovery, with an odds ratio of 0.29.
This finding suggests that the improvement was not explained solely by differences in patient characteristics, gender, or surgical approach.
Safety
No adverse events related to chewing gum were reported.
The intervention was initiated only after patients were fully conscious and had intact airway reflexes, reducing the risk of aspiration or airway obstruction.
This timing is important because chewing gum should not be given to patients who remain excessively sedated, confused, nauseated, or unable to protect their airway.
How chewing gum may work
Chewing gum acts as a form of sham feeding.
Chewing without swallowing food may stimulate:
• Vagal activity
• Salivary secretion
• Gastric and pancreatic secretions
• Gastrointestinal hormone release
• Intestinal smooth-muscle activity
• Coordinated peristalsis
It may also reduce sympathetic inhibition of the gastrointestinal tract following surgery.
These effects can help reverse the temporary reduction in bowel motility caused by surgical manipulation, inflammation, anesthetic medications, and perioperative opioid administration.
Clinical implications
Chewing gum is inexpensive, widely available, and easy to administer.
The study suggests that it may provide several clinically meaningful benefits following abdominal surgery:
• Earlier passage of flatus
• Earlier return of bowel sounds
• Reduced postoperative nausea and vomiting
• Faster resolution of nausea
• Shorter hospitalization
• No apparent intervention-related complications
Chewing gum could therefore be considered as an adjunct to Enhanced Recovery After Surgery protocols.
It should complement rather than replace established recovery strategies such as:
• Early mobilization
• Opioid-sparing analgesia
• Appropriate intravenous fluid management
• Early oral nutrition when appropriate
• Avoidance of unnecessary nasogastric tubes
• Minimally invasive surgical techniques
• Multimodal prevention of postoperative nausea and vomiting
Anesthesia considerations
Anesthesia professionals may have an important role in determining when chewing gum can be started safely.
Before providing chewing gum, the patient should be:
• Fully conscious
• Cooperative
• Able to follow instructions
• Free from significant residual neuromuscular weakness
• Able to swallow normally
• Able to protect the airway
• Not experiencing severe nausea or active vomiting
Patients with aspiration risk, altered mental status, swallowing disorders, facial or oral surgery, severe nausea, or gastrointestinal obstruction may not be appropriate candidates.
Limitations
The study was conducted using a single-blinded design. Patients would generally know whether they were chewing gum, which could introduce performance or reporting bias.
Bowel sounds can be subjective and may vary depending on the examiner and the duration of auscultation.
The study included different types of abdominal operations. Variations in surgical complexity, bowel manipulation, anesthetic technique, opioid exposure, and postoperative feeding could influence gastrointestinal recovery.
The unusually large reduction in hospital stay should be interpreted cautiously because discharge decisions may depend on institutional practices and factors unrelated to bowel function.
Additional multicenter studies would help determine whether these findings are reproducible across different hospitals, surgical populations, and Enhanced Recovery protocols.
Bottom line
Postoperative chewing gum significantly accelerated gastrointestinal recovery following elective abdominal surgery.
Patients receiving chewing gum experienced earlier passage of flatus, earlier return of bowel sounds, less postoperative nausea and vomiting, faster resolution of symptoms, and shorter hospital stays.
No intervention-related adverse events were reported.
Because chewing gum is safe, inexpensive, and simple to implement in appropriately selected and fully awake patients, it may be a useful addition to routine postoperative care and Enhanced Recovery After Surgery pathways.
Thank you to Cureus for allowing us to summarize this article.