Endogenous amylin and glucagon-like peptide-1 concentrations are not associated with gastric emptying in critical illness

Summers, Matthew J.; Bartolomeo, Anna E. Di; Zaknic, Antony V.; Chapman, Marianne J.; Nguyen, Nam Q.; Zacharakis, Betty; Rayner, Christopher K.; Horowitz, Michael; Deane, Adam M.

doi:10.1111/aas.12252

Cited by 13 publications

(17 citation statements)

References 35 publications

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“…Critical illness can influence gastrointestinal hormone levels, resulting in different gastrointestinal pathophysiologic effects. In critically ill adults and preterm neonates, the levels of several hormones have been examined; these studies have been summarized in Table . Differences in patient populations, methodology, and definitions of EN intolerance and gastric emptying may have contributed to variability in results between previous studies and ours.…”

Section: Discussionmentioning

confidence: 99%

“…This approach is consistent with the complex physiologic effect of multiple gastrointestinal hormones on gastrointestinal function. Our results related to amylin, GLP‐1, and glucagon are consistent with previous studies, and the known physiologic effects of these hormones, specifically that increased levels, are associated with limited EN delivery . The relationship between ghrelin and PYY and gastric emptying by C1h differs from previous studies and may represent a unique physiologic response in critically ill children or may be secondary to different study conditions between our study and prior studies .…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11][12] Levels of multiple gastrointestinal hormones have been explored in relation to gastric emptying and EN intolerance in critically ill adults. [13][14][15][16][17] For example, cholecystokinin (CCK) and peptide-YY (PYY) have been reported to be elevated in critically ill adults with delayed gastric emptying. 13,14 Neonatal studies and 1 pediatric study have reported elevated amylin, gastric inhibitory polypeptide (GIP), and PYY levels to be associated with EN intolerance in critical illness.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Gastrointestinal Hormone Profiles Associated With Enteral Nutrition Tolerance and Gastric Emptying in Pediatric Critical Illness: A Pilot Study

Martinez

Panciotti

Pereira

et al. 2019

J Parenter Enteral Nutr

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Background Enteral nutrition (EN) intolerance and delayed gastric emptying are prevalent in pediatric critical illness and limit EN delivery. Gastrointestinal (GI) hormones may be associated with EN intolerance and delayed gastric emptying in this cohort. Methods We determined GI hormone levels, time to achieve 50% of EN goal, and gastric emptying in critically ill children. Total amylin, active ghrelin, total glucagon‐like peptide‐1 (GLP‐1), total gastric inhibitory polypeptide, glucagon, and total peptide‐YY (PYY) were measured by multiplex assay and cholecystokinin by ELISA. Lower concentrations of acetaminophen at 1 hour (C1h, µg/mL) using the acetaminophen absorption test defined delayed gastric emptying. Correlation, regression analyses, and a principal component analysis were used to examine the association between GI hormones and time to 50% EN goal and C1h. Results GI hormones were measured in 14 of 21 patients with gastric emptying testing; median age of 11.2 years (6.74–16.3) and 50% male. Increasing hormone levels from GI hormone profile 1 (GLP‐1, glucagon, and amylin) correlated with greater time to reach 50% EN goal (R2 = 0.296, P = 0.04). Decreasing hormone levels from GI hormone profile 2 (PYY and ghrelin) correlated with lower C1h and slower gastric emptying (R2 = 0.342, P = 0.02). Conclusion GI hormone profiles are associated with time to achieve 50% of EN goal and gastric emptying in critically ill children. We have described a feasible model to study the role of GI hormones in this cohort, including the potential clinical applicability of GI hormone measurement in the management of delayed gastric emptying.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Gastrointestinal Hormone Profiles Associated With Enteral Nutrition Tolerance and Gastric Emptying in Pediatric Critical Illness: A Pilot Study

Martinez

Panciotti

Pereira

et al. 2019

J Parenter Enteral Nutr

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“…Compared with these neutrally mediated effects, there may be more persistent endocrine‐mediated mechanisms. Hormonal pathways are also important and include hormones that slow gastric emptying, such as amylin, cholecystokinin, glucagon‐like peptide‐1, and peptide YY, and hormones that accelerate emptying rate, such as ghrelin and motilin . Such endocrine targets may represent a focus of future therapy, with the most likely candidates being ghrelin and motilin, discussed in detail under the subheading drug therapies.…”

Section: Stomachmentioning

confidence: 99%

“…Targeting amylin is unlikely to be a high priority. In an observational study of 26 critically ill patients and 23 healthy participants as controls, fasting amylin concentrations were comparable between critical illness and health, and the rate of gastric emptying was not related to fasting amylin concentrations, suggesting other targets are more appealing.…”

Section: Stomachmentioning

confidence: 99%

Pathophysiology and Treatment of Gastrointestinal Motility Disorders in the Acutely Ill

et al. 2018

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Gastrointestinal dysmotility causes delayed gastric emptying, enteral feed intolerance, and functional obstruction of the small and large intestine, the latter functional obstructions being frequently termed ileus and Ogilvie syndrome, respectively. In addition to meticulous supportive care, drug therapy may be appropriate in certain situations. There is, however, considerable variation among individuals regarding what gastric residual volume identifies gastric dysmotility and would encourage use of a promotility drug. While the administration of either metoclopramide or erythromycin is supported by evidence it appears that, dual‐drug therapy (erythromycin and metoclopramide) reduces the rate of treatment failure. There is a lack of evidence to guide drug therapy of ileus, but neither erythromycin nor metoclopramide appear to have a role. Several drugs, including ghrelin agonists, highly selective 5‐hydroxytryptamine receptor agonists, and opiate antagonists are being studied in clinical trials. Neostigmine, when infused at a relatively slow rate in patients receiving continuous hemodynamic monitoring, may alleviate the need for endoscopic decompression in some patients.

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Effects of Standard vs Energy‐Dense Formulae on Gastric Retention, Energy Delivery, and Glycemia in Critically Ill Patients

Chapple

Summers

Weinel

et al. 2021

J Parenter Enteral Nutr

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Background: Energy-dense formulae are often provided to critically ill patients with enteral feed intolerance with the aim of increasing energy delivery, yet the effect on gastric emptying is unknown. The rate of gastric emptying of a standard compared with an energy-dense formula was quantified in critically ill patients. Methods: Mechanically ventilated adults were randomized to receive radiolabeled intragastric infusions of 200 mL standard (1 kcal/mL) or 100 mL energy-dense (2 kcal/mL) enteral formulae on consecutive days in this noninferiority, blinded, crossover trial. The primary outcome was scintigraphic measurement of gastric retention (percentage at 120 minutes). Other measures included area under the curve (AUC) for gastric retention and intestinal energy delivery (calculated from gastric retention of formulae over time), blood glucose (peak and AUC), and intestinal glucose absorption (using 3-O-methyl-D-gluco-pyranose [3-OMG] concentrations). Comparisons were undertaken using paired mixedeffects models. Data presented are mean ± SE. Results: Eighteen patients were studied (male/female, 14:4; age, 55.2 ± 5.3 years). Gastric retention at 120 minutes was greater with the energy-dense formula (standard, 17.0 ± 5.9 vs energy-dense, 32.5 ± 7.1; difference, 12.7% [90% confidence interval, 0.8%-30.1%]). Energy delivery (AUC 120 , 13,038 ± 1119 vs 9763 ± 1346 kcal/120 minutes; P = 0.057), glucose control (peak glucose, 10.1 ± 0.3 vs 9.7 ± 0.3 mmol/L, P = 0.362; and glucose AUC 120 8.7 ± 0.3 vs 8.5 ± 0.3 mmol/L.120 minutes, P = 0.661), and absorption (3-OMG AUC 120 , 38.5 ± 4.0 vs 35.7 ± 4.0 mmol/L.120 minutes; P = .508) were not improved with the energy-dense formula. Conclusion: In critical illness, administration of an energy-dense formula does not reduce gastric retention, increase energy delivery to the small intestine, or improve glucose absorption or glucose control; instead, there is a signal for delayed gastric emptying.

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Endogenous amylin and glucagon-like peptide-1 concentrations are not associated with gastric emptying in critical illness

Cited by 13 publications

References 35 publications

Gastrointestinal Hormone Profiles Associated With Enteral Nutrition Tolerance and Gastric Emptying in Pediatric Critical Illness: A Pilot Study

Gastrointestinal Hormone Profiles Associated With Enteral Nutrition Tolerance and Gastric Emptying in Pediatric Critical Illness: A Pilot Study

Pathophysiology and Treatment of Gastrointestinal Motility Disorders in the Acutely Ill

Effects of Standard vs Energy‐Dense Formulae on Gastric Retention, Energy Delivery, and Glycemia in Critically Ill Patients

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