الفهرس 
Normal physiology of gastrointestinal motilityOnly 14 pages are availabe for public view
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Abstract
Postoperative ileus (POI) is a common and clinically important problem occurring after surgical procedures that may contribute to significant postoperative morbidity, including delaying enteral nutrition, causing patient discomfort, and prolonging hospitalization, Several factors may play a role, including spinal-intestinal neural reflexes, generalized sympathetic hyperactivity, local and systemic inflammatory mediators, and other exacerbating influences including exogenous and endogenous opiates and electrolyte abnormalities. Treatment of POI is currently largely supportive and historically has consisted of routine nasogastric intubation, intravenous hydration, and bowel rest. In the past, multiple pharmacologicn agents have been used in the treatment of POI with little consistent success. Efforts aimed at minimizing POI by utilizing epidural anesthetic agents, providing pain control with opioid-sparing agents such as nonsteroidal anti-inflammatory medications, and minimizing invasive surgical techniques have led to improved patient comfort, shorter duration of ileus, and earlier hospital discharge.
Early ambulation may help also to decrease POI and help the rapid return of bowel motility. Opioid-receptor antagonists have shown promise in re¬ducing postoperative ileus but still require further stud¬ies. Multimodality treatment approaches combining sev¬eral therapies may represent a logical approach but require further evaluation in larger, randomized trials, as do novel emerging therapies such as VIP and substance P antagonists or nitric oxide synthesis inhibitors.
Early feeding postoperative was tried as a method to minimize postoperative ileus but it was not proved to be safe and many patients did not tolerate early feeding. Gum chewing as a way of sham feeding was found safe to increase bowel motility without having same risk as early feeding. Gum chewing stimulates bowel motility through stimulating cephalo-vagal reflex and increasing stomach hormones.
This study included 48 patients which had gone elective CS under spinal anesthesia. They were divided into two groups randomly (study group and control group) the study group included 24 patients; they started gum chewing two hours postoperatively for 15 minutes and every two hours till they passed flatus the control group included 24 patients; they had nothing by mouth except for a little amount of water after 12 hr till they passed flatus.