Early Oral Feeding After Esophagectomy Modifies Brain-Gut Peptides

illustration of a gut and someone's brain
Researchers investigated the effects of early oral feeding vs late oral feeding on gut function recovery and brain-gut peptide secretion after esophagectomy.

When compared with traditional late oral feeding, early oral feeding after esophagectomy led to modified levels of brain-gut peptides and earlier postoperative flatus and defecation, according to a study published in Surgery.

For the current study, researchers used data from a randomized clinical trial (ClinicalTrials.gov Identifier: NCT01998230) to examine the effects of early oral feeding on brain-gut peptide secretion and gut function recovery after esophagectomy. Patients (N=110) were randomly assigned 1:1 to receive early oral feeding or late oral feeding on the morning following the operation. The early oral feeding group started oral intake on postoperative day 1, starting with liquids and advancing to soft foods. Patients in the late oral feeding group received nasogastric or nasoenteral feeds until postoperative day 7 before switching to oral intake. Both groups received supplemental parenteral nutrition as needed. Brain-gut peptides were measured the day before surgery and postoperative day 1, 3, and 5. Patients aged older than 80 years and those with severe comorbidities were excluded.

The primary endpoints were perioperative serum brain-gut peptide changes and gut function recovery. Time to first flatus and defecation were also recorded. Secondary endpoints included postoperative complications and length of hospital stay.

Patients in the early oral feeding group vs late oral feeding had higher levels of gastrin (P =.021), motilin (P =.027), and substance-P (P =.023), but lower levels of cholecystokinin (P =.004) and somastatin (P =.019). Additionally, patients in the early oral feeding group had earlier signs of gut function recovery, with both time to first flatus and time to first defecation being a day earlier than in the late oral feeding group. Notably, patients in the early oral feeding group had an average hospital stay of 6 days compared with 12 days for those who received late oral feeding. There were no significant differences between groups in postoperative complications.

Study limitations included the single-center design with a limited number of participants and a lack of data on long-term outcomes of early oral feeding on brain-gut peptides.

“[Brain-gut peptides] seem to play an important role between the [early oral feeding] program and gut function recovery and are possible treatment targets to improve [early oral feeding] benefits and promote personalized [early oral feeding] programs,” the study authors wrote. “[Early oral feeding] may be considered part of standard practice to enhance recovery after esophagectomy.”


Chen X, Wang P, Leng C, et al. Early oral feeding after esophagectomy accelerated gut function recovery by regulating brain-gut peptide secretion. Surgery. 2022;172(3):919-925. doi:10.1016/j.surg.2022.04.041