The amount of nicotine in the gum might have been too low to have any real effect on bowel recovery or inflammation after surgery.
Scientific Claim
The 2 mg dose of nicotine chewing gum used in this study may be insufficient to activate the cholinergic anti-inflammatory pathway in patients undergoing colorectal surgery, as no clinical or biomarker benefits were observed despite mechanistic plausibility.
Original Statement
“This relatively low dose might have potentially been another reason for the lack of efficacy of the nicotine chewing gum in this study... If indeed the effective dose of nicotine would be too low... this might account for the absence of significant differences.”
Evidence Quality Assessment
Claim Status
understated
Study Design Support
Design cannot support claim
Appropriate Language Strength
probability
Can suggest probability/likelihood
Assessment Explanation
The study did not test different doses, so the claim about insufficiency is speculative. The authors' suggestion is reasonable but not proven; 'may be insufficient' is appropriate, but the claim should not imply certainty.
Evidence from Studies
Supporting (1)
Nicotine chewing gum for the prevention of postoperative ileus after colorectal surgery: a multicenter, double-blind, randomised, controlled pilot study
The study gave some patients nicotine gum and others regular gum after bowel surgery, but both groups recovered at the same rate — meaning the nicotine gum didn’t help, likely because 2 mg wasn’t enough to do the job it was supposed to.