Dear Editor,
We read, with great interest, the randomized controlled trial by Byrne _et al
., which concluded that chewing sugar-free gum resulted in an earlier return of bowel function and decreased analgesic requirements. Postoperative ileus (POI) remains an important and common clinical problem after abdominal surgery. Therefore, we compliment the authors for their efforts to investigate the effectiveness of chewing gum – in addition to the existing literature on this topic – which seems to be an inexpensive, safe, and readily available solution to this problem. However, we would like to highlight that in our opinion, the reported primary outcomes do not fully reflect the recovery of bowel function. In a prospective study, van Bree -et al_. demonstrated that the combined end-point of tolerance of solid food (SF) and first defaecation (D) best reflects the recovery of gastrointestinal transit. Additionally, the reported time to flatus might not adequately indicate effective gastrointestinal recovery, but might instead mirror rectal emptying. In order to progress towards more easily comparable results in future research on POI and postoperative gastrointestinal recovery, the consistent use of the abovementioned clinical definition should be considered. We would be grateful if the authors could comment on this matter. Moreover, we believe it will strengthen the conclusion of their trial, if the authors could provide additional results from their valuable data regarding the combined end-point (SF + D).

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Journal Colorectal Disease
Lambrichts, D.P.V, & Lange, J.F. (2018). Response to ‘Gum chewing aids bowel function return and analgesic requirements after bowel surgery: a randomised controlled trial’. Colorectal Disease, 20(5). doi:10.1111/codi.14012