NEW YORK (Reuters Health) – Potentially helpful ways to ameliorate appetite loss after major abdominal surgery include chewing gum, a traditional medicine from Japan, and watching cooking shows, according to a new systematic review and meta-analysis.

The evidence was strongest for chewing gum, and weaker for cooking shows and rikkunshito, a mix of eight herbal medicines, researchers report in Annals of Surgery. Several other approaches also had some evidence in their favor.

None of the 165 studies in the review, 24 of which randomized, controlled trials, evaluated the effects of cannabinoids, nor did they investigate steroids or the appetite stimulant megestrol acetate.

“In our review, we found appetite loss after major abdominal surgery to be a common problem, associated with increased morbidity and reduced quality of life for the patients,” Dr. Martin Wagner of Heidelberg University Hospital, in Germany, told Reuters Health by email.

More-intensive approaches such as parenteral nutrition are possible, but are unpleasant for patients, the researcher and his colleagues note in their paper.

The studies in the review included more than 20,000 patients. The major abdominal surgeries considered in the review were those requiring gastrointestinal anastomosis or involving bowel or parenchymal resection.

A meta-analysis of data from randomized controlled trials found that gum chewing reduced the time to first hunger after bowel surgery by about 21 hours.

One study showed that patients who watched cooking shows had a significantly more rapid return of appetite after surgery than patients who did not. “Surgeons can recommend this uncomplicated method to their patients without further concerns,” the team writes.

Rikkunshito was reported to improve postoperative appetite after gastrointestinal surgery and as having positive effects on cancer-related symptoms, though not all studies of the compound found a benefit, Dr. Wagner cautioned.

Rikkunshito is a traditional Japanese herbal medicine, known in China as liu-jun-zi-tang, he explained. It’s a compound of Atractylodis lanceae rhizoma, Ginseng root, Pinelliae tuber, Hoelen, Chinese date, Aurantii nobilis pericarpium, licorice root, and ginger.

Rikkunshito is taken as a tablet three times a day, Dr. Wagner added, and in the studies included in the review patients took it for three months.

Intravenous synthetic ghrelin, the “appetite hormone,” was found to improve appetite immediately after surgery, but not longer term, and in any case is not available for routine use.

Finally, the researchers concluded that a multidisciplinary counseling program involving medical and nursing staff, dietitians, physical and occupational therapists, and others might improve appetite after hospital discharge.

Dr. John Blundell of the Appetite Control and Energy Balance Research Group at the University of Leeds, in the UK, criticized the study for not including, so far as he could see, any psychologists or other researchers “with expertise in appetite control or the methodology in this area.”

This, and what he called “arbitrary” definitions of appetite, “limited the project and prevented the emergence of truly innovative outcomes,” he told Reuters Health by email.

SOURCE: https://bit.ly/3BQLjXN Annals of Surgery, online January 27, 2022.

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