Antro-pyloro-duodenal motor responses to gastric and duodenal nutrient in critically ill patients

Chapman, M.; Fraser, R.; Vozzo, R.; Bryant, L.; Tam, W.; Nguyen, N.; Zacharakis, B.; Butler, R.; Davidson, G.; Horowitz, M.
October 2005
Gut;Oct2005, Vol. 54 Issue 10, p1384
Academic Journal
Background: Gastric emptying is frequently delayed in critical illness which compromises the success of nasogastric nutrition. The underlying motor dysfunctions are poorly defined. Aims: To characterise antro-pyloro-duodenal motility during fasting, and in response to gastric and duodenal nutrient, as well as to evaluate the relationship between gastric emptying and motility, in the critically ill. Subjects: Fifteen mechanically ventilated patients from a mixed intensive care unit; 10 healthy volunteers. Methods: Antro-pyloro-duodenal pressures were recorded during fasting, after intragastric administration (100 ml; 100 kcal), and during small intestinal infusion of liquid nutrient (6 hours; 1 kcal/min). Gastric emptying was measured using a 13C octanoate breath test. Results: In healthy subjects, neither gastric nor small intestinal nutrient affected antro-pyloro-duodenal pressures. In patients, duodenal nutrient infusion reduced antral activity compared with both fasting and healthy subjects (0.03 (0-2.47) waves/mm v 0.14 (0-2.2) fasting (p = 0.016); and v 0.33 (0-2.57)/min in healthy subjects (p = 0.005)). Basal pyloric pressure and the frequency of phasic pyloric pressure waves were increased in patients during duodenal nutrient infusion (3.12 (1.06) mm Hg; 0.98 (0.13)/min) compared with healthy subjects (-0.44 (1.25) mm Hg; p<0.02 after 120 minutes; 0.29 (0.15)/min; p=0.0002) and with fasting (-0.06 (1.05) mm Hg; p<0.03 after 160 minutes; 0.49 (0.13)/mm; (p =0.0001). Gastric emptying was delayed in patients (gastric emptying coefficient 2.99 (0.2) v 3.47 (0.1); p = 0.015) and inversely related to the number of pyloric pressure waves (r = -0.563, p = 0.029). Conclusions: Stimulation of pyloric and suppression of antral pressures by duodenal nutrient are enhanced in the critically ill and related to decreased gastric emptying.


Related Articles

  • Central Line-Associated Blood Stream Infection in the Critically Ill Trauma Patient. SMITH, JASON W.; EGGER, MICHAEL; FRANKLIN, GLEN; HARBRECHT, BRIAN; RICHARDSON, J. DAVID // American Surgeon;Aug2011, Vol. 77 Issue 8, p1038 

    Blood stream infections in the critically ill are a common cause of morbidity. Strict adherence to sterile technique can reduce central line-associated blood stream infections (CLBSIs) and has become a quality improvement measure. We did a retrospective review of 6,014 trauma admissions...

  • Preparing an ICU room to welcome a critically ill patient with Ebola virus disease. Pasquier, Pierre; Ficko, Cécile; Mérens, Audrey; Dubost, Clément // Intensive Care Medicine;Jan2015, Vol. 41 Issue 1, p118 

    The article describes an Ebola virus disease-intensive care unit (EVD-ICU) room for an EVD patient requiring intensive care.

  • Making Decisions about ICU Care When There is No Next of Kin. Pierson, David J. // Critical Care Alert;Feb2007, Vol. 14 Issue 11, p81 

    This hypothetical scenario is well-known to critical care clinicians, especially those who work in urban public hospitals. How often similar situations occur, and how physicians managing such patients approach the limitation of life-sustaining treatment in such instances in the absence of...

  • Journal of Hospital Medicine: Beds in pediatric intensive care unit could be used more efficiently with improved flow.  // Biomedical Market Newsletter;4/21/2012, Vol. 21, p1 

    The article discusses a study published in the "Journal of Hospital Medicine" which shows that pediatric intensive care unit (PICU) delivered critical care services most of the time as compared to noncritical care services which represent a barrier to access for new patients.

  • Disease Management in Patients with Delirium. Jochum, Thomas; Bär, Karl-Jürgen // Open Critical Care Medicine Journal;Jan2011, Vol. 4, p47 

    Delirium occurs as a pathophysiological state in connection with various diseases, particularly among patients in critical care. Since it may be a life-threatening condition, any physician should be able to initiate correct assessment and treatment of delirium. This review summarizes current...

  • Gastric Residuals Understand Their Significance to Optimize Care. Fessler, Theresa A. // Today's Dietitian;Jun2010, Vol. 12 Issue 6, p11 

    The article discusses the ways to interpret and gain a comprehensive understanding of gastric residual volume (GRV) and offers strategies to enhance enteral nutrition (EN) tolerance in patients. It also examines the case of a patient in a medical intensive care unit (ICU) who was receiving a...

  • Finding Our Way. Weise, Kathryn // Hastings Center Report;Jul/Aug2004, Vol. 34 Issue 4, p0 

    Presents an article about the medical case of Amanda who was transferred in a pediatric intensive care unit because of her array of cardiac anomalies. Members of the medical team that took care of Amanda; Medical interventions applied; Information on the parents of Amanda.

  • Is Acute External Otitis An Overlooked Problem In Intensive Care Unit? Ger�ek, Arzu; Umuroglu, T�may; Sari, Murat; Inanli, Selçuk; G�g�s, F. Yilmaz // Internet Journal of Emergency & Intensive Care Medicine;2005, Vol. 8 Issue 1, p10 

    The article presents information on a study, which examines whether acute external otitis is an overlooked problem in intensive care unit (ICU). In this study, researchers undertook a prospective observational study to analyse the incidence and etiology of acute external otitis in critically ill...

  • Cardiac troponin I in patients with severe exacerbation of chronic obstructive pulmonary disease. Baillard, Christophe; Boussarsar, Mohamed; Fosse, Jean-Philippe; Girou, Emmanuelle; Le Toumelin, Philippe; Cracco, Christophe; Jaber, Samir; Cohen, Yves; Brochard, Laurent // Intensive Care Medicine;Apr2003, Vol. 29 Issue 4, p584 

    Objectives: Co-morbid conditions including risk factors for cardiovascular diseases and left ventricular dysfunction are common in patients with chronic obstructive pulmonary disease (COPD). This study assessed the incidence of cardiac troponin I (cTnI) elevation, a specific marker...


Read the Article


Sign out of this library

Other Topics