Effect of ICU interventions on gastrointestinal motility.

PURPOSE OF REVIEW

Early detection of gastrointestinal motility disturbances is a major goal to reduce the incidence of this potentially disastrous event by prophylactic managements and early goal-directed therapy in patients at risk.

RECENT FINDINGS

Gastroparesis frequently results in the inability to feed critically ill patients, aggravating problems such as bacterial translocation and stress-induced intestinal damage. Recently published data have advanced our understanding of the pathophysiologic background of gastroparesis, intestinal stress damage and the effect of early enteral nutrition on gastrointestinal function. New techniques, such as ultrasound and the capsule techniques, might help to assess intestinal function beyond the aspiration of gastric residual volumes and the passage of stool. Therapeutic options such as opioid antagonists and the 5-hydroxytryptamine receptor 4 agonist prucalopride might help to restore intestinal function.

SUMMARY

Gastrointestinal motility disturbances are caused by a myriad of pathological processes. Moreover, bowel integrity is governed by comorbidity, impaired metabolic function and pharmacological interventions in critically ill patients. Restoring gastrointestinal function, therefore, requires a multimodal approach including prophylactic management strategies and the sensible use of substances with inhibitory effects on intestinal motility.