Your gut is on strike!

What an unusual statement you may wonder. Perhaps some of you have heard this statement or a variant of it – your intestine has gone to sleep, you have an ileus or your gut is not working properly.

The small intestine does not like being ‘handled’ by human hands. Whenever you have an open abdominal operation, be it a colon, stomach, small intestine, bladder or kidney operation, there is a significant likelihood that your small intestine will ‘go to sleep’ for a variable period of time. In response to the surgical insult of being handled or being operated on, the intestine will not function. The lack of small intestinal function is called ileus. During this period the abdomen will swell because the secretions from your mouth, stomach and duodenum will not be absorbed. On top of that if you also eat / drink, then the swelling can get worse and you will experience nausea and vomiting. In most instances, the treatment for an ileus is to insert a tube into the stomach via your nose (a nasogastric tube or NG tube) and set up an intravenous infusion (IVI). The NG tube decompresses your stomach of air and liquid while the IVI keeps you hydrated. How long an ileus lasts varies. At the present moment there are no special medicines that can prevent an ileus from occurring or shorten the duration of an ileus.

Gum chewing has been suggested as a means of reducing the duration of ileus. A recent meta-analysis of all the published data on the effect of gum chewing on ileus duration was published by researchers in the University of Amsterdam (Dig Surg 2008; 25: 39 – 45). There were 5 randomised control trials involving a total of 158 patients. The pooled data showed that the gum chewing group had significantly shorter time to passing flatus (gas) and defaecation compared to the non-gum chewing group. The analysis could not show that gum chewing had a significant influence on the total days spent in hospital.

Ileus can be prolonged if there is underlying infection in the abdominal cavity or abnormal electrolytes level in the blood. When infections and abnormal blood electrolytes are excluded, then we need to ensure that there isn’t an underlying mechanical obstruction or poor blood supply to the intestine. If everything has been excluded then the best and only thing to do is ‘be patient’.

For the patient and relatives, it is almost counter intuitive to not give medicine and do nothing. It is difficult for them to comprehend that we just wait and there is no magic medicine to solve the problem. With fluid support, the ileus will resolve in about 5 to 7 days (sometimes shorter). Occasionally an ileus can last for two to three weeks. In such instances the patient needs to be supported with intravenous nutrition.

Sometimes masterly inaction in medicine is actually doing something. If you want to chew a gum or two while you are waiting, it won’t hurt and maybe just might help.