Early enteral feeding versus "nil by mouth" after gastrointestinal surgery: systematic review and meta-analysis of controlled trials
Stephen J Lewis
BMJ 2001;323:773 ( 6 October )
a Department of Medicine, Addenbrooke's Hospital, Cambridge CB2 2QQ, b MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Bristol BS8 2PR, c Department of Surgery, Bristol Royal Infirmary, Bristol BS2 8HW, d Department of Maxillofacial Surgery, University of Bristol, Bristol BS1 2LY
Correspondence to: S Lewis sjl@doctors.org.uk
Objective: To determine whether a period of starvation (nil
by mouth) after gastrointestinal surgery is beneficial in terms of
specific outcomes.
Design: Systematic review and meta-analysis of randomised controlled
trials comparing any type of enteral feeding started within 24 hours
after surgery with nil by mouth management in elective
gastrointestinal surgery. Three electronic databases (PubMed, Embase,
and the Cochrane controlled trials register) were searched, reference
lists checked, and letters requesting details of unpublished trials
and data sent to pharmaceutical companies and authors of previous trials.
Main outcome measures: Anastomotic dehiscence, infection of any type, wound infection, pneumonia, intra-abdominal abscess, length of hospital
stay, and mortality.
Results: Eleven studies with 837 patients met the inclusion criteria.
In six studies patients in the intervention group were fed directly
into the small bowel and in five studies patients were fed orally.
Early feeding reduced the risk of any type of infection (relative
risk 0.72, 95% confidence interval 0.54 to 0.98, P=0.036)
and the mean length of stay in hospital (number of days reduced by
0.84, 0.36 to 1.33, P=0.001). Risk reductions were
also seen for anastomotic dehiscence (0.53, 0.26 to 1.08, P=0.080),
wound infection, pneumonia, intra-abdominal abscess, and mortality,
but these failed to reach significance (P>0.10). The risk of
vomiting was increased among patients fed early (1.27, 1.01 to
1.61, P=0.046).
Conclusions: There seems to be no clear advantage to keeping patients
nil by mouth after elective gastrointestinal resection. Early feeding
may be of benefit. An adequately powered trial is required to confirm
or refute the benefits seen in small trials.
Efficacy of progesterone and progestogens in management of premenstrual syndrome: systematic review
Katrina Wyatt
a Academic Department of Obstetrics and Gynaecology, Keele
University and North Staffordshire Hospital, Stoke-on-Trent ST4 6QG, b Department
of Mathematics, Keele University, Keele ST5 5BG
Correspondence to: S O'Brien pma06@keele.ac.uk
Objective: To evaluate the efficacy of progesterone and progestogens
in the management of premenstrual syndrome.
BMJ 2001;323:776 ( 6 October )
Design: Systematic review of published randomised, placebo
controlled trials.
Studies reviewed: 10 trials of progesterone therapy (531 women) and four trials of progestogen therapy (378 women).
Main outcome measures: Proportion of women whose symptoms showed improvement
with progesterone preparations (suppositories and oral micronised).
Proportion of women whose symptoms showed improvement with
progestogens. Secondary analysis of efficacy of progesterone and
progestogens in managing physical and behavioural symptoms.
Results: Overall standardised mean difference for all trials
that assessed efficacy of progesterone (by both routes of
administration) was 
0.028
(95% confidence interval 0.017 to 0.040). The odds
ratio was 1.05 (1.03 to 1.08) in favour of progesterone,
indicating no clinically important difference between progesterone
and placebo. For progestogens the overall standardised mean was 0.036
(0.014 to 0.060),
which corresponds to an odds ratio of 1.07 (1.03 to 1.11)
showing a statistically, but not clinically, significant improvement
for women taking progestogens.
Conclusion: The evidence from these meta-analyses does not
support the use of progesterone or progestogens in the management of
premenstrual syndrome.
