Small intestinal motor patterns in critically ill patients after major abdominal surgery

Tournadre, JP; Barclay, Murray L.; Fraser, Robert; Young, Robert J.; Berce, Michael; Jury, Paul; Fergusson, L; Burnett, Jim

doi:10.1016/s0002-9270(01)02514-x

Cited by 13 publications

(13 citation statements)

References 26 publications

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“…The results confirm that gastric emptying of a liquid nutrient is delayed in about 50% of critically ill patients, and demonstrate that there is an inverse relationship between gastric emptying and phasic pyloric activity. Our observations relating to interdigestive motor activity complement those from previous studies [21][22][23][24][25] in that critically ill patients have less antral MMC activity with similar, or a tendency to more frequent but atypical, duodenal MMC activity and a lack of inhibition of fasting motility by nutrient.…”

Section: Discussionsupporting

confidence: 86%

“…[21][22][23][24][25] Duodenal MMC intervals are highly variable in both health and critical illness but appear to be shorter in the latter. [21][22][23][24][25] In the critically ill, the mean MMC duration during fasting ranges from 32 to 91 minutes, [21][22][23][24][25] and may be shortened by the use of opiates 23 or dopamine, 24 and increases as patients recover. 23 In this study, the duodenal MMC interval fell within this range and tended to be shorter than in healthy subjects.…”

Section: Discussionmentioning

confidence: 99%

“…20 The motor dysfunctions responsible for slow gastric emptying in the critically ill are poorly defined, and the amount of available information is limited. [21][22][23][24][25] Early studies documented reduced postprandial antral activity and absent fasting antral activity fronts, with relatively normal numbers of duodenal pressure waves 21 and, possibly, more frequent activity fronts. 23 The persistence of fasting activity during feeding is a feature of critical illness [22][23][24][25][26] which may compromise the success of jejunal nutrition.…”

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confidence: 99%

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Antro-pyloro-duodenal motor responses to gastric and duodenal nutrient in critically ill patients

Chapman

2005

Gut

102

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Background: Gastric emptying is frequently delayed in critical illness which compromises the success of nasogastric nutrition. The underlying motor dysfunctions are poorly defined. Aims: To characterise antro-pyloro-duodenal motility during fasting, and in response to gastric and duodenal nutrient, as well as to evaluate the relationship between gastric emptying and motility, in the critically ill. Subjects: Fifteen mechanically ventilated patients from a mixed intensive care unit; 10 healthy volunteers. Methods: Antro-pyloro-duodenal pressures were recorded during fasting, after intragastric administration (100 ml; 100 kcal), and during small intestinal infusion of liquid nutrient (6 hours; 1 kcal/min). Gastric emptying was measured using a 13 C octanoate breath test. Results: In healthy subjects, neither gastric nor small intestinal nutrient affected antro-pyloro-duodenal pressures. In patients, duodenal nutrient infusion reduced antral activity compared with both fasting and healthy subjects (0.03 (0-2.47) waves/min v 0.14 (0-2.2) fasting (p = 0.016); and v 0.33 (0-2.57)/min in healthy subjects (p = 0.005)). Basal pyloric pressure and the frequency of phasic pyloric pressure waves were increased in patients during duodenal nutrient infusion

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Antro-pyloro-duodenal motor responses to gastric and duodenal nutrient in critically ill patients

Chapman

2005

Gut

102

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“…We use time to flatus as a parameter for recovery of bowel function and not time to first defecation. 35 Food intake stimulates colonic motility by means of gastrocolic reflex in early postoperative patients as it does in healthy controls. 33 Edema and inflammation in the postsurgical intestines could potentially affect contractile forces and absorptive capacity; however, early feeds have been shown to decrease intestinal inflammation and improve nutrient permeability.…”

Section: Discussionmentioning

confidence: 99%

Early Use of Low Residue Diet Is Superior to Clear Liquid Diet After Elective Colorectal Surgery

Lau

Phillips²,

Bresee

et al. 2014

Annals of Surgery

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“…Da die Dünndarmmotilität meist schon am ersten postoperativen Tag nachweisbar ist, kann die Ernährung bei Patienten, die Nahrung oral nicht aufnehmen können (z. B. wegen Intubation), alternativ auch über intestinale Ernährungssonden erfolgen[80,122]. Stewart et al konnten in einer prospektiv randomisierten Studie mit 40 Patienten nach elektivem kolorektalen Eingriff zeigen, dass ein 4 Stunden postoperativ beginnender Kostaufbau zu einer Verkürzung des postoperativen Ileus und zu einem verkürzten Klinikaufenthalt führt[113].…”

unclassified

Postoperativer Ileus: Teil II (Klinische Therapie)

Kreis

Kasparek²,

Becker³

et al. 2003

Zentralbl Chir

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To avoid or reduce postoperative ileus, the operative trauma should be minimized and epidural anesthesia for spinal inhibition of the sympathetic nervous system or i. v. lidocaine should be used, all of which probably act by reducing visceral afferent nerve fiber activity. Recent data suggest that perioperative fluid restriction might reduce postoperative ileus. Epidural anesthesia with local anesthetics and replacing opioids by non-steroidal anti-inflammatory drugs (NSAIDs) for postoperative pain treatment improve the recovery of gastrointestinal motility disturbances. Prior to the operation, the patient should be informed regarding postoperative motility disorders, its length and the presumed resumption of oral food intake, which has been shown to shorten hospital stay. Early postoperative food intake stimulates small and large bowel motility via interenteric reflex arches, avoids i. v. lines and renders discharge acceptable for the patient. Treatment of postoperative ileus includes osmotic laxatives and prokinetic drugs like erythromycine and acetylcholinesterase inhibitors. By combining epidural anesthesia and the sparse use of i. v. opioids with early food intake and, if necessary, laxatives or prokinetics, postoperative ileus should be coped adequately. Nevertheless, the development of new specific prokinetic drugs with minimal or no side effects should remain a target for drug companies to further improve treatment of postoperative ileus.

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Small intestinal motor patterns in critically ill patients after major abdominal surgery

Cited by 13 publications

References 26 publications

Antro-pyloro-duodenal motor responses to gastric and duodenal nutrient in critically ill patients

Antro-pyloro-duodenal motor responses to gastric and duodenal nutrient in critically ill patients

Early Use of Low Residue Diet Is Superior to Clear Liquid Diet After Elective Colorectal Surgery

Postoperativer Ileus: Teil II (Klinische Therapie)

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