Gastrointestinal motility and prokinetics in the critically ill

Purpose of reviewEnteral nutrition is frequently unsuccessful in the critically ill due to gastrointestinal dysfunction. Current treatment strategies are often disappointing. In this article upper gastrointestinal function in health together with abnormalities seen during critical illness are reviewed, and potential therapeutic options summarized. Recent findingsReflux oesophagitis occurs frequently due to reduced or absent lower oesophageal sphincter tone. In the stomach a number of motor patterns contribute to slow gastric emptying. The fundus has reduced compliance, there are less frequent contractions in both the proximal and distal stomach, isolated pyloric activity is increased and the organization of duodenal motor activity is abnormal. In response to nutrients, enterogastric feedback is enhanced, fundic relaxation and subsequent recovery is delayed, antral motility is further reduced and localized pyloric contractions stimulated. Elevated concentrations of hormones such as cholecystokinin and peptide YY are potential mediators for these phenomena. Rapid tachyphylaxis occurs with the commonly used prokinetics, metoclopramide and erythromycin, and novel agents are under investigation. Independent of gastric emptying, nutrient absorption is reduced. SummaryThere has been considerable progress in understanding the pathogenesis of mechanisms causing feed intolerance in critical illness, but this is yet to be translated into therapeutic benefit.

[1]  M. Bellon,et al.  Glucose absorption and gastric emptying in critical illness , 2009, Critical care.

[2]  M. Ferrone,et al.  Prokinetic Therapy for Feed Intolerance in Critical Illness: One Drug or Two? , 2008, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[3]  N. Nguyen,et al.  Erythromycin is more effective than metoclopramide in the treatment of feed intolerance in critical illness* , 2007, Critical care medicine.

[4]  J. Wishart,et al.  Feed intolerance in critical illness is associated with increased basal and nutrient‐stimulated plasma cholecystokinin concentrations* , 2007, Critical care medicine.

[5]  A. Darzi,et al.  Meta‐analysis: alvimopan vs. placebo in the treatment of post‐operative ileus , 2006, Alimentary pharmacology & therapeutics.

[6]  A. Girbes,et al.  Fecal energy losses in enterally fed intensive care patients: an explorative study using bomb calorimetry. , 2006, Clinical nutrition.

[7]  A. Zinsmeister,et al.  Double‐blind, randomized, placebo‐controlled study to evaluate the effects of tegaserod on gastric motor, sensory and myoelectric function in healthy volunteers , 2006, Alimentary pharmacology & therapeutics.

[8]  N. Nguyen,et al.  Proximal gastric response to small intestinal nutrients is abnormal in mechanically ventilated critically ill patients. , 2006, World journal of gastroenterology.

[9]  G. Farrugia,et al.  Proliferation of the interstitial cells of Cajal is induced by serotonin through 5-HT2B receptors , 2006 .

[10]  N. Nguyen,et al.  Long-standing type II diabetes mellitus is not a risk factor for slow gastric emptying in critically ill patients , 2006, Intensive Care Medicine.

[11]  W. Snape,et al.  1 Gastric myoelectrical activity compared to pyloric pressure in patients with gastroparesis , 2006 .

[12]  K. Ho,et al.  A comparison of early gastric and post-pyloric feeding in critically ill patients: a meta-analysis , 2006, Intensive Care Medicine.

[13]  M. Larsson.  The dendritic cell: the immune system's adjuvant--a strategy to develop a HCV vaccine? , 2006, Gastroenterology.

[14]  J. Dent,et al.  Distal small bowel motility and lipid absorption in patients following abdominal aortic aneurysm repair surgery. , 2006, World journal of gastroenterology.

[15]  S. Brett,et al.  Changes in appetite related gut hormones in intensive care unit patients: a pilot cohort study , 2005, Critical care.

[16]  R. Rossaint,et al.  Effects of propofol and fentanyl on duodenal motility activity in pigs. , 2005, The Canadian veterinary journal = La revue veterinaire canadienne.

[17]  B. Joelsson,et al.  Ischemic Colitis, Irritable Bowel Syndrome, and Tegaserod—An Alternative Viewpoint , 2005, Pharmacotherapy.

[18]  S. Vanner,et al.  Basic and clinical pharmacology of new motility promoting agents , 2005, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[19]  A. Zinsmeister,et al.  Effect of alvimopan and codeine on gastrointestinal transit: a randomized controlled study. , 2005, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[20]  M. Chapman,et al.  Erythromycin dose of 70 mg accelerates gastric emptying as effectively as 200 mg in the critically ill , 2005, Intensive Care Medicine.

[21]  Richard Hall,et al.  The Use of Tegaserod in Critically ill Patients with Impaired Gastric Motility , 2005, Clinical pharmacology and therapeutics.

[22]  M. Horowitz,et al.  Antro-pyloro-duodenal motor responses to gastric and duodenal nutrient in critically ill patients , 2005, Gut.

[23]  J. DiBaise.  Tegaserod‐Associated Ischemic Colitis , 2005, Pharmacotherapy.

[24]  R. Fraser,et al.  A Novel Technique for Post-pyloric Feeding Tube Placement in Critically Ill Patients: A Pilot Study , 2005, Anaesthesia and intensive care.

[25]  D. Spain,et al.  Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients* , 2005, Critical care medicine.

[26]  K. Shingu,et al.  Propofol and Midazolam Inhibit Gastric Emptying and Gastrointestinal Transit in Mice , 2004, Anesthesia and analgesia.

[27]  Jim Mele.  Tegaserod and ischemic colitis. , 2004, The New England journal of medicine.

[28]  K. Shingu,et al.  A New Method Using Flow Cytometry to Measure the Effects of Drugs on Gastric Emptying and Gastrointestinal Transit in Mice , 2004, Arzneimittelforschung.

[29]  E. Wooltorton.  Tegaserod (Zelnorm) for irritable bowel syndrome: reports of serious diarrhea and intestinal ischemia , 2004, Canadian Medical Association Journal.

[30]  R. Bellomo,et al.  Establishment of enteral nutrition: prokinetic agents and small bowel feeding tubes , 2004, Current opinion in critical care.

[31]  H. Watson,et al.  Low-dose oral vitamin K therapy for the management of asymptomatic patients with elevated international normalized ratios: a brief review , 2004, Canadian Medical Association Journal.

[32]  J. R. Boulton-Jones,et al.  Experience of post-pyloric feeding in seriously ill patients in clinical practice. , 2004, Clinical nutrition.

[33]  J. Richard,et al.  Gastric emptying in mechanically ventilated critically ill patients: effect of neuromuscular blocking agent , 2003, Intensive Care Medicine.

[34]  P. Marik,et al.  Gastric versus post-pyloric feeding: a systematic review , 2003, Critical care.

[35]  N. Nguyen,et al.  Mechanisms of gastroesophageal reflux in critically ill mechanically ventilated patients. , 2003, Gastroenterology.

[36]  K. Reinhart,et al.  Enteral naloxone reduces gastric tube reflux and frequency of pneumonia in critical care patients during opioid analgesia , 2003, Critical care medicine.

[37]  N. Nathoo,et al.  To determine the effect of metoclopramide on gastric emptying in severe head injuries: A prospective, randomized, controlled clinical trial , 2003, British journal of neurosurgery.

[38]  N. Roewer,et al.  Clonidine and Dexmedetomidine Potently Inhibit Peristalsis in the Guinea Pig Ileum In Vitro , 2002, Anesthesiology.

[39]  C. Yap,et al.  Tolerability of bolus versus continuous gastric feeding in brain-injured patients , 2002, Neurological research.

[40]  B. Allaouchiche,et al.  Effects of Subhypnotic Doses of Propofol on Gastric Emptying in Volunteers , 2002, Anesthesiology.

[41]  G. Dobb,et al.  Metoclopramide-Induced Raised Intracranial Pressure After Head Injury , 2002, Journal of neurosurgical anesthesiology.

[42]  G. Varga.  Dexloxiglumide Rotta Research Lab. , 2002, Current opinion in investigational drugs.

[43]  J. Moss,et al.  Selective postoperative inhibition of gastrointestinal opioid receptors. , 2002, The New England journal of medicine.

[44]  C. Beglinger,et al.  Tegaserod, a 5‐HT4 receptor partial agonist, accelerates gastric emptying and gastrointestinal transit in healthy male subjects , 2001, Alimentary pharmacology & therapeutics.

[45]  M. Boivin,et al.  Gastric feeding with erythromycin is equivalent to transpyloric feeding in the critically ill , 2001, Critical Care Medicine.

[46]  J. Dent,et al.  Delayed gastric emptying in ventilated critically ill patients: Measurement by 13C-octanoic acid breath test , 2001, Critical care medicine.

[47]  M. Wattwil,et al.  Propofol and gastric effects of morphine , 2001, Acta anaesthesiologica Scandinavica.

[48]  M. Schuster-Bruce.  Gastric emptying in the critically ill. , 2001, Critical care medicine.

[49]  P. Factor,et al.  GI complications in patients receiving mechanical ventilation. , 2001, Chest.

[50]  J. Dent,et al.  Impacts and patterns of disturbed gastrointestinal function in critically ill patients , 2000, American Journal of Gastroenterology.

[51]  P. Singer,et al.  The paracetamol absorption test: a useful addition to the enteral nutrition algorithm? , 2000, Clinical nutrition.

[52]  M. Buist,et al.  Erythromycin improves gastric emptying in critically ill patients intolerant of nasogastric feeding , 2000, Critical care medicine.

[53]  J. Jamart,et al.  Effect of dopamine on gastrointestinal motility during critical illness , 2000, Intensive Care Medicine.

[54]  Castedal,et al.  Effects of midazolam on small bowel motility in humans , 2000, Alimentary pharmacology & therapeutics.

[55]  J. Montejo.  Enteral nutrition-related gastrointestinal complications in critically ill patients: a multicenter study. The Nutritional and Metabolic Working Group of the Spanish Society of Intensive Care Medicine and Coronary Units. , 1999, Critical care medicine.

[56]  N. Qvist,et al.  The effects of omeprazole on intragastric pH, intestinal motility, and gastric emptying rate. , 1999, Scandinavian journal of gastroenterology.

[57]  J. Tack,et al.  Duodenogastroesophageal reflux and esophageal mucosal injury in mechanically ventilated patients. , 1999, Gastroenterology.

[58]  J. Mustoe,et al.  Metoclopramide improves gastric motility in critically ill patients , 1999, Intensive Care Medicine.

[59]  M. Wattwil,et al.  Dopamine delays gastric emptying and prolongs orocaecal transit time in volunteers. , 1999, European journal of anaesthesiology.

[60]  M. Samsom,et al.  Gastrointestinal motility and gastric tube feeding in mechanically ventilated patients. , 1998, Critical care medicine.

[61]  T. Yen,et al.  Gastric emptying in head-injured patients , 1998, American Journal of Gastroenterology.

[62]  M. Wattwil,et al.  Propofol sedation and gastric emptying in volunteers , 1998, Acta anaesthesiologica Scandinavica.

[63]  J. Sutton,et al.  Opioid‐induced Delay in Gastric Emptying: A Peripheral Mechanism in Humans , 1997, Anesthesiology.

[64]  P. Boesiger,et al.  Role of cholecystokinin in the regulation of liquid gastric emptying and gastric motility in humans: studies with the CCK antagonist loxiglumide , 1997, Gut.

[65]  G. V. Van Citters,et al.  Stopping enteral feeding for arbitrary gastric residual volume may not be physiologically sound: results of a computer simulation model. , 1997, JPEN. Journal of parenteral and enteral nutrition.

[66]  R. Whelpton,et al.  A model of gastric emptying using paracetamol absorption in intensive care patients , 1997, Intensive Care Medicine.

[67]  D. Cook,et al.  Impaired gastric emptying in mechanically ventilated, critically ill patients , 1996, Intensive Care Medicine.

[68]  J. Jamart,et al.  Effect of erythromycin on gastric motility in mechanically ventilated critically ill patients: a double-blind, randomized, placebo-controlled study. , 1995, Critical care medicine.

[69]  A. Bossuyt,et al.  Gastric emptying in critically ill patients is accelerated by adding cisapride to a standard enteral feeding protocol: results of a prospective, randomized, controlled trial. , 1995, Critical care medicine.

[70]  I. Chaudry,et al.  Severe depression of gut absorptive capacity in patients following trauma or sepsis. , 1993, The Journal of trauma.

[71]  I. Chaudry,et al.  Tumor necrosis factor depresses gut absorptive function. , 1993, Circulatory shock.

[72]  J. Dent,et al.  Hyperglycaemia stimulates pyloric motility in normal subjects. , 1991, Gut.

[73]  J. Dent,et al.  Hyperglycaemia slows gastric emptying in Type 1 (insulin-dependent) diabetes mellitus , 1990, Diabetologia.

[74]  F. Andreasen,et al.  Antroduodenal motility, pH and gastric emptying during balanced anaesthesia: comparison of pethidine and fentanyl. , 1989, British journal of anaesthesia.

[75]  Y. Taché,et al.  Intracerebroventricular pressure inhibits gastric antral and duodenal contractility but not acid secretion in conscious rabbits. , 1988, Gastroenterology.

[76]  R. Liddle,et al.  Regulation of gastric emptying in humans by cholecystokinin. , 1986, The Journal of clinical investigation.

[77]  A. Zinsmeister,et al.  Effect of opiate and adrenergic blockers on the gut motor response to centrally acting stimuli. , 1984, Gastroenterology.

[78]  C. Scarpignato,et al.  Different effects of cimetidine and ranitidine on gastric emptying in rats and man , 1982, Agents and Actions.

[79]  M. Rees,et al.  The effect on paracetamol absorption of stimulation and blockade of beta-adrenoceptors. , 1980, British journal of clinical pharmacology.

[80]  Is tegaserod associated with ischaemic colitis? , 2004 .

[81]  G. Doig,et al.  Parenteral vs. enteral nutrition in the critically ill patient: a meta-analysis of trials using the intention to treat principle , 2004, Intensive Care Medicine.

[82]  M. Hansen,et al.  Neurohumoral control of gastrointestinal motility. , 2003, Physiological research.

[83]  P. Tooley,et al.  Cardiac arrhythmias reported during treatment with cisapride , 1999, Pharmacoepidemiology and drug safety.

[84]  H. Schmidt-Matthiesen.  Prevention and Treatment of Postoperative Ileus , 1986 .

[85]  J. Hideg,et al.  The role of adrenergic receptors in the regulation of gastric motility in the rat. , 1975, Zeitschrift fur experimentelle Chirurgie.