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Antro-pyloro-duodenal motor responses to gastric and duodenal nutrient in critically ill patients.
Gut. 2005 Oct; 54(10):1384-90.Gut

Abstract

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 (3.12 (1.06) mm Hg; 0.98 (0.13)/min) compared with healthy subjects (-0.44 (1.25) mm Hg; p<0.02 after 120 minutes; 0.29 (0.15)/min; p = 0.0002) and with fasting (-0.06 (1.05) mm Hg; p<0.03 after 160 minutes; 0.49 (0.13)/min; (p = 0.0001). Gastric emptying was delayed in patients (gastric emptying coefficient 2.99 (0.2) v 3.47 (0.1); p = 0.015) and inversely related to the number of pyloric pressure waves (r = -0.563, p = 0.029).

CONCLUSIONS

Stimulation of pyloric and suppression of antral pressures by duodenal nutrient are enhanced in the critically ill and related to decreased gastric emptying.

Authors+Show Affiliations

Intensive Care Unit, Royal Adelaide Hospital, North Terrace, Adelaide, Australia. mchapman@mail.rah.sa.gov.auNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15923669

Citation

Chapman, M, et al. "Antro-pyloro-duodenal Motor Responses to Gastric and Duodenal Nutrient in Critically Ill Patients." Gut, vol. 54, no. 10, 2005, pp. 1384-90.
Chapman M, Fraser R, Vozzo R, et al. Antro-pyloro-duodenal motor responses to gastric and duodenal nutrient in critically ill patients. Gut. 2005;54(10):1384-90.
Chapman, M., Fraser, R., Vozzo, R., Bryant, L., Tam, W., Nguyen, N., Zacharakis, B., Butler, R., Davidson, G., & Horowitz, M. (2005). Antro-pyloro-duodenal motor responses to gastric and duodenal nutrient in critically ill patients. Gut, 54(10), 1384-90.
Chapman M, et al. Antro-pyloro-duodenal Motor Responses to Gastric and Duodenal Nutrient in Critically Ill Patients. Gut. 2005;54(10):1384-90. PubMed PMID: 15923669.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antro-pyloro-duodenal motor responses to gastric and duodenal nutrient in critically ill patients. AU - Chapman,M, AU - Fraser,R, AU - Vozzo,R, AU - Bryant,L, AU - Tam,W, AU - Nguyen,N, AU - Zacharakis,B, AU - Butler,R, AU - Davidson,G, AU - Horowitz,M, Y1 - 2005/05/29/ PY - 2005/6/1/pubmed PY - 2005/12/13/medline PY - 2005/6/1/entrez SP - 1384 EP - 90 JF - Gut JO - Gut VL - 54 IS - 10 N2 - 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 (3.12 (1.06) mm Hg; 0.98 (0.13)/min) compared with healthy subjects (-0.44 (1.25) mm Hg; p<0.02 after 120 minutes; 0.29 (0.15)/min; p = 0.0002) and with fasting (-0.06 (1.05) mm Hg; p<0.03 after 160 minutes; 0.49 (0.13)/min; (p = 0.0001). Gastric emptying was delayed in patients (gastric emptying coefficient 2.99 (0.2) v 3.47 (0.1); p = 0.015) and inversely related to the number of pyloric pressure waves (r = -0.563, p = 0.029). CONCLUSIONS: Stimulation of pyloric and suppression of antral pressures by duodenal nutrient are enhanced in the critically ill and related to decreased gastric emptying. SN - 0017-5749 UR - https://www.unboundmedicine.com/medline/citation/15923669/Antro_pyloro_duodenal_motor_responses_to_gastric_and_duodenal_nutrient_in_critically_ill_patients_ L2 - https://gut.bmj.com/lookup/pmidlookup?view=long&amp;pmid=15923669 DB - PRIME DP - Unbound Medicine ER -