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The role of perioperative chewing gum on gastric fluid volume and gastric pH: a meta-analysis.
Ouanes, JP, Bicket, MC, Togioka, B, Tomas, VG, Wu, CL, Murphy, JD
Journal of clinical anesthesia. 2015;(2):146-52
Abstract
STUDY OBJECTIVE To determine if preoperative gum chewing affects gastric pH and gastric fluid volume. DESIGN Systematic review and meta-analysis. METHODS Data sources included Cochrane, PubMed, and EMBASE databases from inception to June 2012 and reference lists of known relevant articles without language restriction. Randomized controlled trials in which a treatment group that chewed gum was compared to a control group that fasted were included. Relevant data, including main outcomes of gastric fluid volume and gastric pH, were extracted. RESULTS Four studies involving 287 patients were included. The presence of chewing gum was associated with small but statically significant increases in gastric fluid volume (mean difference = 0.21 mL/kg; 95% confidence interval, 0.02-0.39; P = .03) but not in gastric pH (mean difference = 0.11 mL/kg; 95% confidence interval, -0.14 to 0.36; P = .38). Gastric fluid volume and gastric pH remained unchanged in subgroup analysis by either sugar or sugarless gum type. CONCLUSIONS Chewing gum in the perioperative period causes small but statically significant increases in gastric fluid volume and no change in gastric pH. The increase in gastric fluid most likely is of no clinical significance in terms of aspiration risk for the patient. Elective surgery should not necessarily be canceled or delayed in healthy patients who accidentally chew gum preoperatively.
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Effects of chewing on appetite, food intake and gut hormones: A systematic review and meta-analysis.
Miquel-Kergoat, S, Azais-Braesco, V, Burton-Freeman, B, Hetherington, MM
Physiology & behavior. 2015;:88-96
Abstract
OBJECTIVES To seek insights into the relationship between chewing, appetite, food intake and gut hormones, and to consider potentially useful recommendations to promote benefits of chewing for weight management. MATERIALS AND METHODS Papers were obtained from two electronic databases (Medline and Cochrane), from searches of reference lists, and from raw data collected from the figures in the articles. A total of 15 papers were identified that detailed 17 trials. All 15 papers were included in the systematic review; however, a further five studies were excluded from the meta-analysis because appropriate information on hunger ratings was not available. The meta-analysis was conducted on a total of 10 papers that detailed 13 trials. RESULTS Five of 16 experiments found a significant effect of chewing on satiation or satiety using self-report measures (visual analogue scales, VASs). Ten of 16 experiments found that chewing reduced food intake. Three of five studies showed that increasing the number of chews per bite increased relevant gut hormones and two linked this to subjective satiety. The meta-analysis found evidence of both publication bias and between study heterogeneity (IA(2) = 93.4%, tau(2) = 6.52, p < 0.001) which decreased, but remained, when covariates were considered. Analysis of the heterogeneity found a substantial effect of the fasting period where the duration of fasting influenced the decrease in hunger due to chewing. Prolonged mastication significantly reduces self-reported hunger levels (hunger: − 2.31 VAS point, 95% CI [− 4.67, − 1.38], p < 0.001). CONCLUSIONS Evidence currently suggests that chewing may decrease self-reported hunger and food intake, possibly through alterations in gut hormone responses related to satiety. Although preliminary, the results identify a need for additional research in the area. Focused, uniform, experimental designs are required to clearly understand the relationships that exist between mastication, appetite, satiety, food intake and, ultimately, body weight.
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3.
Chewing gum reduces postoperative ileus following abdominal surgery: a meta-analysis of 17 randomized controlled trials.
Li, S, Liu, Y, Peng, Q, Xie, L, Wang, J, Qin, X
Journal of gastroenterology and hepatology. 2013;(7):1122-32
Abstract
BACKGROUND AND AIM Chewing gum proposal has been used in surgery to reduce postoperative ileus for more than 10 years; however, the efficacy remains imprecise. The aim of this study was to accurately assess whether the use of the chewing gum could reduce duration of postoperative ileus following the abdominal surgery. METHODS A systematic review was conducted in Medline, EMBASE, and the Cochrane Library through December 2012 to identify randomized controlled trials comparing with and without the use of chewing gum in patients undergoing abdominal surgery. The outcome of interest was time to flatus, time to bowel movement, and length of stay. Subgroup analyses were performed to examine the impact of different studies structural design. Cumulative meta-analyses were used to examine how the evidence has changed over time. RESULTS Seventeen randomized controlled trials involving 1374 participants were included. Overall time (in days) for the patients to pass flatus (weighted mean difference [WMD], -0.31; 95% confidence interval [CI], -0.43 to -0.19; P = 0.000); time to bowel movement (WMD, -0.51; 95% CI, -0.73 to -0.29; P = 0.000); and length of stay (WMD, -0.72; 95% CI, -1.02 to -0.43; P = 0.000) were significantly reduced in the treatment group. However, both of these results demonstrated significant heterogeneity. No evidence of publication bias was observed. Cumulative meta-analysis showed that chewing gum reduces duration of postoperative ileus that has been available for over 6 years. CONCLUSIONS Results of the meta-analysis suggest that chewing gum following abdominal surgery offers benefits in reducing the time of postoperative ileus.
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Associations between the masticatory system and muscle activity of other body districts. A meta-analysis of surface electromyography studies.
Perinetti, G, Türp, JC, Primožič, J, Di Lenarda, R, Contardo, L
Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology. 2011;(6):877-84
Abstract
The aim of this meta-analysis regarding the use of surface electromyography (sEMG) is to assess the scientific evidence for detectable correlations between the masticatory system and muscle activity of the other body districts, particularly those mainly responsible for body posture. A literature survey was performed using the PubMed database, covering the period from January 1966 to April 2011, and choosing medical subject headings. After selection, five articles qualified for the final analysis. One study article was judged to be of medium quality, the remaining four of low quality. No study included a control group or follow-up; in only one study, subjects with impairment of the masticatory system were enrolled. In all studies, detectable correlations between the masticatory systems and muscle activity of the other body districts, or vice versa, were found; however, after a reappraisal of the data provided in these studies, only weak correlations were found, which reached biological, but not clinical relevance. With the limitations that arise from the poor methodological quality of the published study reports discussed here, the conclusion is that a correlation between the masticatory system and muscle activity of the other body districts might be detected through sEMG under experimental conditions; however, this correlation has little clinical relevance. While more investigations with improved levels of scientific evidence are needed, the current evidence does not support clinically relevant correlations between the masticatory system and the muscle activity of other body districts, including those responsible for body posture.