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

Abstract

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.

Effect of nutrition status and inflammatory stimuli on ghrelin and peptide‐YY levels among critically ill children: A prospective and observational study

“…These studies have shown that levels of glucagon‐like peptide 1 (GLP‐1), PYY, and ghrelin were statistically higher in critically ill populations compared with healthy controls. This was linked with delayed gastric emptying, enteral nutrition (EN) intolerance, and poor clinical outcomes 9–12 …”

“…[6][7][8] Emerging studies recorded alterations in the levels of these gut hormones among critically ill adults. [9][10][11][12] These studies have shown that levels of glucagon-like peptide 1 (GLP-1), PYY, and ghrelin were statistically higher in critically ill populations compared with healthy controls. This was linked with delayed gastric emptying, enteral nutrition (EN) intolerance, and poor clinical outcomes.…”

“…During critical illness, series of metabolic, inflammatory, and endocrine changes take place as part of the body's response to a severe insult 6–8 . Emerging studies recorded alterations in the levels of these gut hormones among critically ill adults 9–12 . These studies have shown that levels of glucagon‐like peptide 1 (GLP‐1), PYY, and ghrelin were statistically higher in critically ill populations compared with healthy controls.…”

“…This was linked with delayed gastric emptying, enteral nutrition (EN) intolerance, and poor clinical outcomes. [9][10][11][12] A limited number of studies have been performed in critically ill children that have proposed an association between the abnormalities seen in the gut hormone level during critical illness with the patient's clinical characteristics. In a small pilot study, we demonstrated that inflammatory activation was associated with increased GLP-1 levels in critically ill children.…”

Point-of-Care Gastric Ultrasound Confirms the Inaccuracy of Gastric Residual Volume Measurement by Aspiration in Critically Ill Children: GastriPed Study

“…Early enteral nutrition (EN) is recommended in critically ill children receiving invasive and non-invasive ventilation mechanical support (1). However, EN tolerance may be challenging in this setting by multifactorial gastroparesis and paralytic ileus (opioid use, bed rest, altered gut hormone secretion, plasmaelectrolyte disturbances, systemic inflammatory response syndrome) (2)(3)(4). The resulting increase in gastric volume may potentially lead to vomiting and aspiration and result in ventilation-associated pneumonia (VAP), the occurrence of which remains low in children (5,6).…”