Gut mucosal atrophy after a short enteral fasting period in critically ill patients

Hernández, Glenn; Velasco, N; Wainstein, Carol; Castillo, Luis; Bugedo, Guillermo; Maíz, Alberto; López, Francisco; Guzmán, Sergio; Vargas, Claudio

doi:10.1016/s0883-9441(99)90017-5

Cited by 171 publications

(84 citation statements)

References 14 publications

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“…Intestinal villi increase height during intensive nutrient absorption during lactation (21) or after small intestine resection (22). Conversely, the mucosa atrophies in patients subjected to starvation, exhibiting reduced villous height and crypt length and impaired intestinal permeability (23). Prolonged loss of function in the intestine over long period of time was associated with even more pronounced morphologic changes 30 days after surgery.…”

Section: Discussionmentioning

confidence: 99%

Changes in Morphology and Function in Small Intestinal Mucosa After Roux-en-Y Surgery in a Rat Model

Kovalenko

Basson

2012

Journal of Surgical Research

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Section: Discussionmentioning

confidence: 99%

Changes in Morphology and Function in Small Intestinal Mucosa After Roux-en-Y Surgery in a Rat Model

Kovalenko

Basson

2012

Journal of Surgical Research

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“…4 In utero, the fetal intestinal mucosa appears to be maintained, at least in part, by swallowing amniotic fluid. Failure to swallow amniotic fluid results in disorganized and rudimentary small bowel mucosa.…”

Section: Discussionmentioning

confidence: 99%

“…One factor is the disuse atrophy of the intestinal mucosa that can develop if a patient is fasted for several days. 4 We previously sought to reduce this mucosal atrophy in VLBW neonates by enterally administering a sterile, isotonic, noncaloric, growth factor-containing solution patterned after human amniotic fluid. [5][6][7][8][9][10][11] This experimental solution has the electrolyte composition of amniotic fluid and contains albumin and two enterocyte growth factors that are present in human amniotic fluid and approved by the US Food and Drug Administration (albeit for different indications); recombinant human erythropoietin and recombinant human granulocyte colony-stimulating factor.…”

Section: Introductionmentioning

confidence: 99%

Enteral Administration of a Simulated Amniotic Fluid to Very Low Birth Weight Neonates

et al. 2005

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DO OBJECTIVE:To reduce feeding intolerance among very low birth weight neonates. STUDY DESIGN:A total of 10 neonates with birth weights of 750 to 1250 g were given oralgastric boluses (2.5 ml/kg every 3 hours) of a solution patterned after amniotic fluid. When milk feedings were begun the milk was mixed with the test solution. The solution was given at a constant daily dose of 20 ml/ kg/day while the volumes of milk feedings were gradually increased. When milk feedings reached 80 ml/kg/day the test solution was discontinued. A comparison group consisted of neonates who met study criteria but were cared for during the period immediately preceding the study. The outcome was the number of calories taken enterally over the first 21 days of life. RESULTS:The test solution was begun an average of 27 hours after birth (range, 4 to 45). In the test group the first milk feedings were introduced 74 hours after birth (range, 18 to 144), which was similar to the time milk was introduced in the comparison subjects (79 hours; range, 18 to 168). After milk feedings were started, the test patients had a total of four NPO days (0.4 NPO days per patient) during their first 21 days, while the comparison group had 34 NPO days (3.4 NPO days per patient). During the first 14 days of life the test solution recipients had a median of 26.5 enteral cal/kg/day (range, 4.3 to 68.9), while the comparison neonates had 8.5 (range, 0.2 to 25; p<0.05). During the first 21 days of life the test solution recipients had a median of 56.9 enteral cal/kg/day (range, 11.5 to 89.4), while the comparison neonates had 19.2 (range, 0.9 to 52.8; p<0.05). CONCLUSION:In all, 10 VLBW infants tolerated the test solution for periods up to 14 days with no significant adverse effects. A randomized trial to determine whether this solution reduces feeding intolerance among VLBW neonates should be conducted.

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“…The aetiology is likely to be multi-factorial and can relate to increased gastrointestinal transit [69] , reduced intestinal absorption [70] , disturbed carbohydrate fermentation from altered bowel flora [67] , and the hyper-osmolar effects of enteral feeds [67,68] , leading to osmotic diarrhoea in most patients. Consequently, diarrhoea is more frequently observed in patients who receive enteral feeding at a high rate (e.g., greater than 50 mL/h) [71] , which improves when the rate of enteral feeding is reduced [67,68] .…”

Section: Cardiovascular Side Effectsmentioning

confidence: 99%

Pharmacological therapy of feed intolerance in the critically ills

Nguyen¹

2014

WJGPT

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Feed intolerance in the setting of critical illness is associated with higher morbidity and mortality, and thus requires promptly and effective treatment. Prokinetic agents are currently considered as the first-line therapy given issues relating to parenteral nutrition and postpyloric placement. Currently, the agents of choice are erythromycin and metoclopramide, either alone or in combination, which are highly effective with relatively low incidence of cardiac, hemodynamic or neurological adverse effects. Diarrhea, however, can occur in up to 49% of patients who are treated with the dual prokinetic therapy, which is not associated with Clostridium difficile infection and settled soon after the cessation of the drugs. Hence, the use of prokinetic therapy over a long period or for prophylactic purpose must be avoided, and the indication for ongoing use of the drug(s) must be reviewed frequently. Second line therapy, such as total parenteral nutrition and post-pyloric feeding, must be considered once adverse effects relating the prokinetic therapy develop.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words: Adverse effects; Critical illness; Enteral feeding; Feed intolerance; Prokinetic therapyCore tip: Feed intolerance during critical illness must be promptly recognized and treated due to the associated morbidity and mortality. The current first line treatment for feed intolerance is prokinetic therapy with erythromycin and metoclopramide (alone or in combination), which are highly effective and free of significant adverse effects. Although diarrhoea occurs commonly after combination prokinetic therapy, it is not associated with Clostridium difficile colitis and settled shortly after stopping the treatment. The use of prokinetic therapy over a long period or for prophylactic purpose, therefore, must be avoided and the indication for ongoing use of the drug(s) should be frequently reviewed.Nguyen NQ. Pharmacological therapy of feed intolerance in the critically ills.

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Gut mucosal atrophy after a short enteral fasting period in critically ill patients

Cited by 171 publications

References 14 publications

Changes in Morphology and Function in Small Intestinal Mucosa After Roux-en-Y Surgery in a Rat Model

Changes in Morphology and Function in Small Intestinal Mucosa After Roux-en-Y Surgery in a Rat Model

Enteral Administration of a Simulated Amniotic Fluid to Very Low Birth Weight Neonates

Pharmacological therapy of feed intolerance in the critically ills

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