M1722 Abnormalities in Plasma Motilin Response to Small Intestinal Nutrient Stimulation in Critically Ill Patients

Nguyen, Nam Q.; Fraser, Robert; Bryant, Laura; Burgstad, Carly M.; Chapman, Marianne J.; Clarke, Steven K.; Holloway, Richard H.

doi:10.1016/s0016-5085(10)61865-3

Cited by 5 publications

(4 citation statements)

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“…Активность гладких мышц желудка регулируются внутренней миогенной активностью, сигналами от парасимпатической и симпатической энтеральной нервной системы, также некоторыми гормонами [11]. Основным механизмом, приводящим к этим нарушениям, является первичная двигательная дисфункция желудка с нарушением координации между его проксимальным и дистальным отделом [12,13] в результате дисбаланса гормонов, секретируемых GIT, таких как грелин [14], холецистокинин, пептид YY [15], мотилин [16]. У пациентов в критическом состоянии задержка опорожнения желудка возрастает по мере прогрессирования тяжести заболевания [17].…”

Section: Discussionunclassified

Efficacy of Nasogastric and Nasojejunal Enteral Feeding in the Early Phase of Acute Pacreatitis

Sivkov

Sivkov²,

Popov³

et al. 2021

Obŝaâ reanimatologiâ

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Enteral nutrition in the early phase of predicted severe acute pancreatitis can be administered via a nasogastric or nasojejunal tube. Finding the most effective method in terms of daily balance, the volume of feeding and residual gastric volume in the early period of moderate and severe acute pancreatitis is a current challenge.The aim of the study was to estimate the efficacy of nasogastric and nasojejunal early enteral feeding duringthe early phase of predicted severe acute pancreatitis.Material and methods. The study was prospective, single-center, and randomized. The data were collected from November 2012 to October 2018. The study included 64 ICU patients in the early period of acute pancreatitis exhibiting predictors of severity. During randomization, the patients were assigned to either nasogastric (group 1) or nasojejunal (group 2) feeding for the next four days. The volume of enteral feeding on Day 1 was 250 ml/day, and on each successive day it was increased by 250 ml/day. During group allocation, the disease severity and the way of nutrient administration were taken into account. Daily balance was calculated using the difference between enterally administered and residual gastric volume. Statistical analysis was performed using SPSS v.23 software package. The null hypothesis was rejected at P0.05.Results. The volume of enteral nutrition administered over 4 days did not differ between the study groups. Patients with severe acute pancreatitis had significantly better nutrient absorption over 4 days when the postpyloric route was used (1.63±0.98 l/d) vs the nasogastric one (0.55±0.29 l/d) (P=0.001). In moderate pancreatitis, the enteral nutrition absorption over 4 days did not differ (P=0.107) between the groups with nasogastric (2.06±0.87 l/day) and nasojejunal (2.6±0.45 l/day) feeding.Conclusion. Nasojejunal route is the preferred way to start enteral feeding in patients with severe acute pancreatitis. In moderate acute pancreatitis, feeding can be initiated via the gastric route and only in case of intolerance it should be switched to the nasojejunal one.

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Section: Discussionunclassified

Efficacy of Nasogastric and Nasojejunal Enteral Feeding in the Early Phase of Acute Pacreatitis

Sivkov

Sivkov²,

Popov³

et al. 2021

Obŝaâ reanimatologiâ

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“…Although fasting motilin plasma concentrations have been shown to be similar in critically ill patients and healthy subjects, plasma motilin levels are significantly higher in the patients during nutrient infusion. Furthermore, in critically ill patients there is an inverse relationship between the peak increase in plasma motilin concentrations and the peak change in proximal gastric volume induced by duodenal nutrient stimulation—a finding that may explain the persistence in interdigestive GI contractile activity and the impaired proximal gastric relaxation during enteral feeding in these patients [ 28 ].…”

Section: Stomachmentioning

confidence: 99%

Gastrointestinal dysmotility in critically ill patients

Ladopoulos

Giannaki

Alexopoulou

et al. 2018

aog

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Gastrointestinal (GI) motility disorders are commonly present in critical illness. Up to 60% of critically ill patients have been reported to experience GI dysmotility of some form necessitating therapeutic intervention. It has been attributed to various factors, related to both the underlying disease and the therapeutic interventions undertaken. The assessment of motility disturbances can be challenging in critically ill patients, as the available tests used to detect abnormal motility have major limitations in the setting of an Intensive Care Unit. Critically ill patients with GI dysmotility require a multifaceted treatment approach that addresses multiple causes and utilizes multiple pharmacological pathways. In this review, we discuss the pathophysiology, assessment and management of GI dysmotility in critically ill patients.

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“…Plasma motilin concentrations may be increased during such infusions, rather than decreased as in healthy volunteers (Nguyen et al, 2010). The reasons for these differences are not clear.…”

Section: Dysregulation Of the Hungry Human Stomachmentioning

confidence: 99%

“…Phase III-like activity persists in mechanically ventilated patients with critical illness, following perfusion of the small intestine with liquid nutrients (Chapman et al, 2005 ). Plasma motilin concentrations may be increased during such infusions, rather than decreased as in healthy volunteers (Nguyen et al, 2010 ). The reasons for these differences are not clear.…”

Section: Dysregulation Of the Hungry Human Stomachmentioning

confidence: 99%

The Hungry Stomach: Physiology, Disease, and Drug Development Opportunities

Sanger¹,

Hellström²,

Näslund³

2011

Front. Pharmacol.

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During hunger, a series of high-amplitude contractions of the stomach and small intestine (phase III), which form part of a cycle of quiescence and contractions (known as the migrating motor complex, MMC), play a “housekeeping” role prior to the next meal, and may contribute toward the development of hunger. Several gastrointestinal (GI) hormones are associated with phase III MMC activity, but currently the most prominent is motilin, thought to at least partly mediate phase III contractions of the gastric MMC. Additional GI endocrine and neuronal systems play even more powerful roles in the development of hunger. In particular, the ghrelin-precursor gene is proving to have a complex physiology, giving rise to three different products: ghrelin itself, which is formed from a post-translational modification of des-acyl-ghrelin, and obestatin. The receptors acted on by des-acyl-ghrelin and by obestatin are currently unknown but both these peptides seem able to exert actions which oppose that of ghrelin, either indirectly or directly. An increased understanding of the actions of these peptides is helping to unravel a number of different eating disorders and providing opportunities for the discovery of new drugs to regulate dysfunctional gastric behaviors and appetite. To date, ghrelin and motilin receptor agonists and antagonists have been described. The most advanced are compounds which activate the ghrelin and motilin receptors which are being progressed for disorders associated with gastric hypomotility.

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M1722 Abnormalities in Plasma Motilin Response to Small Intestinal Nutrient Stimulation in Critically Ill Patients

Cited by 5 publications

References 0 publications

Efficacy of Nasogastric and Nasojejunal Enteral Feeding in the Early Phase of Acute Pacreatitis

Efficacy of Nasogastric and Nasojejunal Enteral Feeding in the Early Phase of Acute Pacreatitis

Gastrointestinal dysmotility in critically ill patients

The Hungry Stomach: Physiology, Disease, and Drug Development Opportunities

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