Techniques in Coloproctology | 2021
Caffeine and bowel recovery after elective colorectal resection: author’s reply
Abstract
We thank Dr Korolkiewicz for his thoughtful comment on our article “Does caffeine enhance bowel recovery after elective colorectal resection? A prospective double-blinded randomized clinical trial” [1] recently published in Techniques in Coloproctology. Dr Korolkiewicz suggests an interesting modification to the design of caffeine administration to optimize its beneficial effect on bowel recovery after surgery. We agree with the idea of achieving a steady-state concentration of caffeine in patients’ blood prior to surgery, to achieve a maximal biological effect. Nevertheless, our aim was to create a protocol that would maximally simulate real life environment. This is the reason, for example, for the caffeine dose we selected; 100 mg is the amount of caffeine in an average cup of coffee, and most people who drink coffee do well with three cups per day. Applying study conclusions to real life would mean consumption of caffeine-containing beverages (coffee, tea etc.) in the perioperative period as the simplest way to administer caffeine. We routinely use a mechanical bowel preparation in patients undergoing elective colectomy, and not many patients would like to consume caffeine-containing beverages during the bowel preparation or immediately postoperatively. In addition, we do not recommend consumption of beverages that are not clear along with the bowel preparation. Hence the decision to start administering caffeine on postoperative day 1. The CaCo trial [2], which is an ongoing double-blinded, placebo-controlled, randomized trial comparing the effect of different doses of caffeine versus placebo on bowel recovery after elective colectomy, is also randomizing patients to study groups only after the surgical procedure. Similarly, coffee was administered only starting on postoperative day 1 in previously published studies on the effect of coffee on bowel recovery following surgery [3, 4]. We can only assume the logic leading to the similar design was the same in all cases: creating an investigational environment that would realistically simulate real life.