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World J Gastrointest Pharmacol Ther. Aug 6, 2017; 8(3): 174-179
Published online Aug 6, 2017. doi: 10.4292/wjgpt.v8.i3.174
Critically ill patients and gut motility: Are we addressing it?
Alfredo Vazquez-Sandoval, Shekhar Ghamande, Salim Surani
Alfredo Vazquez-Sandoval, Shekhar Ghamande, Scott and White Medical Center, Texas A and M University, Aransas Pass, TX 78336, United States
Salim Surani, Department of Medicine, Division of Pulmonary and Critical Care, Texas A and M University, Aransas Pass, TX 78336, United States
Author contributions: Vazquez-Sandoval A, Ghamande S and Surani S was involved in design, research; Vazquez-Sandoval A and Surani S wrote the manuscript; all authors reviewed the final article.
Conflict-of-interest statement: None of the authors have conflicts of interest to disclose regarding this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Salim Surani, MD, MPH, MSHM, FACP, FCCP, Clinical Associate Professor, Department of Medicine, Division of Pulmonary and Critical Care, Texas A and M University, Aransas Pass, TX 78336, United States. surani@medicine@tamhsc.edu
Telephone: +1-361-8857722 Fax: +1-361-8507563
Received: January 18, 2017
Peer-review started: January 20, 2017
First decision: May 3, 2017
Revised: May 18, 2017
Accepted: July 14, 2017
Article in press: July 15, 2017
Published online: August 6, 2017
Processing time: 194 Days and 7.4 Hours
Abstract

Gastrointestinal (GI) dysmotility is a common problem in the critically ill population. It can be a reflection and an early sign of patient deterioration or it can be an independent cause of morbidity and mortality. GI dysmotility can be divided for clinical purposes on upper GI dysmotility and lower GI dysmotility. Upper GI dysmotility manifests by nausea, feeding intolerance and vomiting; its implications include aspiration into the airway of abdominal contents and underfeeding. Several strategies to prevent and treat this condition can be tried and they include prokinetics and post-pyloric feeds. It is important to note that upper GI dysmotility should be treated only when there are clinical signs of intolerance (nausea, vomiting) and not based on measurement of gastric residual volumes. Lower GI dysmotility manifests throughout the spectrum of ileus and diarrhea. Ileus can present in the small bowel and the large bowel as well. In both scenarios the initial treatment is correction of electrolyte abnormalities, avoiding drugs that can decrease motility and patient mobilization. When this fails, in the case of small bowel ileus, lactulose and polyethylene glycol solutions can be useful. In the case of colonic pseudo obstruction, neostigmine, endoscopic decompression and cecostomy can be tried when the situation reaches the risk of rupture. Diarrhea is also a common manifestation of GI dysmotility and the most important step is to differentiate between infectious sources and non-infectious sources.

Keywords: Gut motility; Gut dysmotility; Intensive care unit; Gastrointestinal issues in intensive care unit; Ileus

Core tip: This manuscript presents the case for a cautious look at the gastrointestinal (GI) system during critical illness. GI dysfunction can be an early sign of decompensation, but unfortunately is often overlooked due to the natural tendency to gravitate towards the cardiovascular, respiratory and renal systems when looking for decompensation signs. It is our intention to bring attention to this system and help the clinician in using the GI tract as an early marker for decompensation and also to identify and treat potential GI complications common in this population.