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Gastric emptying and the organization of antro‐duodenal pressures in the critically ill
Author(s) -
Chapman M. J.,
Fraser R. J.,
Bryant L. K.,
Vozzo R.,
Nguyen N. Q.,
Tam W.,
Zacharakis B.,
Davidson G.,
Butler R.,
Horowitz M.
Publication year - 2008
Publication title -
neurogastroenterology and motility
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.489
H-Index - 105
eISSN - 1365-2982
pISSN - 1350-1925
DOI - 10.1111/j.1365-2982.2007.00984.x
Subject(s) - gastroenterology , gastric emptying , medicine , critically ill , intestinal motility , bolus (digestion) , critical illness , duodenal ulcer , stomach , parenteral nutrition , motility , biology , genetics
The motor dysfunctions underlying delayed gastric emptying (GE) in critical illness are poorly defined. Our aim was to characterize the relationship between antro‐duodenal (AD) motility and GE in critically ill patients. AD pressures were recorded in 15 mechanically ventilated patients and 10 healthy volunteers for 2 h (i) during fasting, (ii) following an intragastric nutrient bolus with concurrent assessment of GE using the 13 C‐octanoate breath test and (iii) during duodenal nutrient infusion. Propagated waves were characterized by length and direction of migration. Critical illness was associated with: (i) slower GE (GEC: 3.47 ± 0.1 vs 2.99 ± 0.2; P = 0.046), (ii) fewer antegrade (duodenal: 44% vs 83%, AD: 16% vs 83%; P < 0.001) and more retrograde (duodenal: 46% vs 12%, AD: 38% vs 4%; P < 0.001) waves, (iii) shorter wave propagation (duodenal: 4.7 ± 0.3 vs 6.0 ± 0.4 cm; AD: 7.7 ± 0.6 vs 10.9 ± 0.9 cm; P = 0.004) and (iv) a close correlation between GE with the percentage of propagated phase 3 waves that were antegrade ( r = 0.914, P = 0.03) and retrograde ( r = −0.95, P = 0.014). In critical illness, the organization of AD pressure waves is abnormal and associated with slow GE.