Hypothesis: Hexitols in Chewing Gum May Play a Role in Reducing Postoperative Ileus

Gum-chewing has been suggested as a method to stimulate bowel motility and shorten postoperative ileus after colorectal surgery. Patients chewing gum pass flatus, and have bowel movement, earlier than those having ordinary postoperative treatment, and have a lower incidence of postoperative complications. The mechanisms suggested in order to explain this phenomena are all centered in the action of chewing, that may act on cephalic-vagal stimulation of digestion, producing hormones associated with bowel motility, or as sham feeding, stimulating the motility of the duodenum, stomach, and rectum, or by stimulation of secretion of saliva, and pancreatic juices. Interestingly, no suggestions are made about the possible effects of the ingredients of these gums. Sorbitol and other hexitols are key ingredients in most 'sugar-free' chewing gums and candies. Ingestion of relatively small amounts of sorbitol causes gastrointestinal symptoms like gas, bloating, and abdominal cramps in a dose dependent manner. Therefore, the hypothesis suggested herein is that the content of maxitols in 'sugar-free' chewing gums may play a role in the amelioration of ileus after surgery, and should be added to the list of probable mechanisms involved in the observed phenomena.