Motility Disorders of the Upper Gastrointestinal Tract in the Intensive Care Unit

Abstract

Upper gastrointestinal (GI) dysmotility, an entity commonly found in the intensive care unit setting, can lead to insufficient nutrient intake while increasing the risk of infection and mortality. Further, overcoming the altered motility with early enteral feeding is associated with a reduced incidence of infectious complications in intensive care unit patients. Upper GI dysmotility in critical care patients is a common occurrence, and there are many causes for this problem, which affects a very heterogenous population with a multitude of underlying medical abnormalities. Therefore, it is of utmost importance to identify this widespread problem and subsequently institute a proper therapy as rapidly as possible. Prokinetic pharmacotherapies are currently the mainstay for the management of disordered upper GI motility. Future therapies, aimed at the underlying pathophysiology of this complex problem, are under investigation. These aim is to reduce the side effects of the currently available options, while improving on nutrition delivery in the critically ill. This review discusses the pathophysiology, clinical manifestations, diagnosis, and treatment of upper GI motility disturbances in the critically ill.

Nitric oxide-mediated injury of interstitial cells of Cajal and intestinal dysmotility under endotoxemia of mice

“…Gastrointestinal dysmotility is frequently observed under septic conditions and postoperative states (21,26,32), yet its precise mechanisms remain to be elucidated. Local inflammation with leukocyte infiltration in the gastrointestinal tract and systemic inflammation appeared to be involved in prolonged motor disturbance during sepsis.…”

“…Paralytic ileus or gastrointestinal stasis is frequently observed under septic conditions. The gastrointestinal abnormalities under these conditions are characterized by a decrease in gastric emptying and delayed intestinal transit (26). Most phenomena under septic conditions can be reproduced by the administration of bacterial products including lipopolysaccharides (LPS), the signals of which are transduced via specific receptors on the plasma membrane of leukocytes, such as Toll-like receptor-4 (TLR4); thus, LPS is considered to be a major player in sepsis and gastrointestinal stasis (4,12,18,21).…”

Non–anti-infective Effects of Antimicrobials and Their Clinical Applications

“…55 When erythromycin is administered intravenously, it induces strong, high-amplitude phasic contractions that enhance gastric emptying, antral contractions, and antroduodenal coordination. [56][57][58] However, a study comparing metoclopramide use and erythromycin use in critically ill patients 59 found that metoclopramide was significantly better at accelerating gastric emptying in critically ill patients compared with erythromycin. 58,59 A significant problem with macrolide treatment in gastrointestinal dysmotility is tachyphylaxis.…”

Effect of sucralfate on gastric permeability in an ex vivo model of stress‐related mucosal disease in dogs

“…During critical illness, several factors contribute to the loss of gastric mucosal barrier defenses. Splanchnic hypoperfusion occurs, reducing gastric motility, and prolonging exposure of gastric mucosa to acid and other irritants. Decreased gastric microcirculation diminishes acid‐buffering capacity and mucus and bicarbonate secretion .…”