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Pathophysiology and Treatment of Gastrointestinal Motility Disorders in the Acutely Ill

Deane, AM; Chapman, MJ; Reintam Blaser, A; McClave, SA; Emmanuel, A; (2018) Pathophysiology and Treatment of Gastrointestinal Motility Disorders in the Acutely Ill. Nutrition in Clinical Practice 10.1002/ncp.10199. (In press). Green open access

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Abstract

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.

Type: Article
Title: Pathophysiology and Treatment of Gastrointestinal Motility Disorders in the Acutely Ill
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1002/ncp.10199
Publisher version: https://doi.org/10.1002/ncp.10199
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: critical illness, enteral nutrition, gastrointestinal motility, gastroparesis, prescription drugs
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Inst for Liver and Digestive Hlth
URI: https://discovery.ucl.ac.uk/id/eprint/10058835
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