Gastrointestinal Motility Disorders in Critically Ill

Govil, Deepak; Pal, Divya

doi:10.5005/jp-journals-10071-23614

Cited by 9 publications

(4 citation statements)

References 9 publications

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“…Its clinical manifestations are abdominal distension, vomiting, and diarrhea caused by more gastric residues, as well as intestinal dyskinesia, stress ulcer, and gastrointestinal bleeding [ 17 ]. When these symptoms appear at the same time, the mortality of patients can be significantly increased [ 3 ]. GD caused by sepsis is mainly mediated by inflammation, which can destroy the integrity of intestinal epithelium and the ability of immune response, leading to GD [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Gastrointestinal tract is the main target organ and “stress response center” of sepsis. Gastrointestinal dysfunction (GD) is the most common and important prognostic factor in multiple organ dysfunction syndrome (MODS) [ 3 ]. Similarly, GD is also the “starting organ”, which can expand the inflammatory response and affect the prognosis of sepsis [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Acupuncture Enhances Gastrointestinal Motility and Improves Autonomic Nervous Function in Patients with Septic Gastrointestinal Dysfunction

Ban

Huang

et al. 2022

Computational and Mathematical Methods in Medicine

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Gastrointestinal dysfunction (GD) is a common complication after endotoxemia, which can further aggravate the progress of infection. Acupuncture uses metal needles of different shapes and techniques to stimulate specific points on the human body, which are effective in treating various diseases, including gastrointestinal diseases. We aimed at exploring the clinical effect of acupuncture on the recovery of visceral sensation, proximal gastric compliance, and autonomic nervous function in patients with septic GD. A total of 73 sepsis with GD patients were selected using modified single section ultrasonography combined with clinical symptoms in the First People’s Hospital of Lanzhou City during 2019. The participants were randomly allocated to routine-treatment (control group) and study group receiving acupuncture. The indexes before and after treatment included gastric residue, gastric dilatation, pressure and volume, gastric compliance, autonomic nerve function, APACHE II score, and infection index were measured and compared. Before treatment, there was no significant difference in the basic information of the two groups, including gastric volume and pressure, gastric residue, gastric compliance, autonomic nerve function, and APACHE II score. After treatment, the maximum gastric volume and pressure, gastric residue, and APACHE II score of the two groups were significantly improved ( P < 0.05 ). In addition, the maximum gastric volume and pressure of the study group were significantly higher, while gastric residual, autonomic nerve function, and APACHE II were significantly lower than those of the control group ( P < 0.05 ). However, our results showed that acupuncture did not further reduce inflammatory markers, including white blood cells, C-reactive protein, and procalcitonin. To sum up, on the basis of basic treatment, the application of acupuncture can further improve the clinical symptoms of GD in patients with sepsis, enhance gastrointestinal motility, and improve autonomic nervous function, which is worthy of clinical application and promotion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acupuncture Enhances Gastrointestinal Motility and Improves Autonomic Nervous Function in Patients with Septic Gastrointestinal Dysfunction

Ban

Huang

et al. 2022

Computational and Mathematical Methods in Medicine

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“…Immune activation-induced dysmotility and hypophagia are ostensibly evolutionary strategies the animal utilizes to survive an immune challenge. Anorexia decreases nutrient availability for proliferating enteric pathogens ( Wang et al, 2016 ) and increased intestinal motility decreases the enteric pathogen load ( Govil and Pal, 2020 ). In this scenario, although LPS was administered peripherally, the animal still employs GIT strategies in an attempt to minimize the presumed enteric antigens.…”

Section: Discussionmentioning

confidence: 99%

Calcium trafficking and gastrointestinal physiology following an acute lipopolysaccharide challenge in pigs

Opgenorth,

Mayorga,

Abeyta

et al. 2024

Journal of Animal Science

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The influence of systemic immune activation on whole-body Ca trafficking and gastrointestinal tract (GIT) physiology are not clear. Thus, study objectives were to characterize the effects of lipopolysaccharide (LPS) on Ca pools and GIT dynamics to increase understanding of immune-induced hypocalcemia, ileus and stomach hemorrhaging. Twelve crossbred pigs [44 ± 3 kg body weight (BW)] were randomly assigned to 1 of 2 intramuscular treatments: (1) control (CON; 2 mL saline; n=6) or (2) LPS (40 µg LPS/kg BW; n=6). Pigs were housed in metabolism stalls to collect total urine and feces for 6 h after treatment administration, at which point they were euthanized, and various tissues, organs, fluids, and digesta were weighed, and analyzed for Ca content. Data were analyzed with the MIXED procedure in SAS 9.4. Rectal temperature and respiration rate increased in LPS relative to CON pigs (1.4°C and 32%, respectively; P≤0.05). Inflammatory biomarkers such as circulating alkaline phosphatase, aspartate aminotransferase, and total bilirubin increased in LPS compared with CON pigs whereas albumin decreased (P≤0.02). Plasma glucose and urea nitrogen decreased and increased, respectively, after LPS (43 and 80%, respectively; P<0.01). Pigs administered LPS had reduced circulating ionized Ca (iCa) compared to CON (15%; P<0.01). Considering estimations of total blood volume, LPS caused an iCa deficit of 23 mg relative to CON (P<0.01). Adipose tissue and urine from LPS pigs had reduced Ca compared to CON (39 and 77%, respectively; P≤0.05). There did not appear to be increased Ca efflux into GIT contents and no detectable increases in other organ or tissue Ca concentrations were identified. Thus, while LPS caused hypocalcemia, we were unable to determine where circulating Ca was trafficked. LPS administration markedly altered GIT dynamics including stomach hemorrhaging, diarrhea (increased fecal output and moisture), and reduced small intestine and fecal pH (P ≤ 0.06). Taken together, changes in GIT physiology suggested dyshomeostasis and alimentary pathology. Future research is required to fully elucidate the etiology of immune activation-induced hypocalcemia and GIT pathophysiology.

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“…Although the most prominent and frequent clinical sign of CDI is diarrhea, the symptoms may range from mild gastrointestinal discomfort to severe pseudomembranous colitis and to toxic megacolon with paralytic ileus [ 26 ]. Gastrointestinal motility disorders which include gastroparesis, ileus, and acute colonic pseudo-obstruction are common in critically ill ICU patients [ 27 ], another possible reason for CDI underdiagnosis among these patients. The issue of underdiagnosing C. difficile was highlighted by Davies et al [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Clostridioides difficile and Vancomycin-Resistant Enterococci in COVID-19 Patients with Severe Pneumonia

Bogdanová

Doubravská

Vágnerová

et al. 2021

Life

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Broad-spectrum antibiotics administered to patients with severe COVID-19 pneumonia pose a risk of infection caused by Clostridioides difficile. This risk is reduced mainly by strict hygiene measures and early de-escalation of antibiotic therapy. Recently, oral vancomycin prophylaxis (OVP) has also been discussed. This retrospective study aimed to assess the prevalence of C. difficile in critical COVID-19 patients staying in an intensive care unit of a tertiary hospital department of anesthesiology, resuscitation, and intensive care from November 2020 to May 2021 and the rates of vancomycin-resistant enterococci (VRE) after the introduction of OVP and to compare the data with those from controls in the pre-pandemic period (November 2018 to May 2019). During the COVID-19 pandemic, there was a significant increase in toxigenic C. difficile rates to 12.4% of patients, as compared with 1.6% in controls. The peak rates were noted in February 2021 (25% of patients), immediately followed by initiation of OVP, changes to hygiene precautions, and more rapid de-escalation of antibiotic therapy. Subsequently, toxigenic C. difficile detection rates started to fall. There was a nonsignificant increase in VRE detected in non-gastrointestinal tract samples to 8.9% in the COVID-19 group, as compared to 5.3% in the control group. Molecular analysis confirmed mainly clonal spread of VRE.

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Gastrointestinal Motility Disorders in Critically Ill

Cited by 9 publications

References 9 publications

Acupuncture Enhances Gastrointestinal Motility and Improves Autonomic Nervous Function in Patients with Septic Gastrointestinal Dysfunction

Acupuncture Enhances Gastrointestinal Motility and Improves Autonomic Nervous Function in Patients with Septic Gastrointestinal Dysfunction

Calcium trafficking and gastrointestinal physiology following an acute lipopolysaccharide challenge in pigs

Clostridioides difficile and Vancomycin-Resistant Enterococci in COVID-19 Patients with Severe Pneumonia

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