Gastrointestinal hypomotility
The critically ill positive pressure ventilated patients had decreased
gastric and duedonal contractility. This may be due to Cajal cell (GI
motor activity control unit) dysfunction, pre-existing disease,
endotoxin secretion, corticotropin releasing factor secretion during
stress and drugs27,31.
Delayed gastric emptying
Delayed gastric emptying is a common problem in intensive care units in
the patients with MV. In the absence of mechanical obstruction,
vomiting, bloating feeding intolerance and demonstrating the delayed
emptying with ‘gastric emptying scintigraphy’,
‘13C-octanoate acid gastric emptying breath test’ or
‘acetaminophen absorption test’ is sufficient to diagnose.
Supine position, infections, obesity, frequent suctioning, hiatal
hernia, increased intracranial pressure and gastrotomy tube placement
may lead delayed gastric emptying. Also electrolyte disturbances and
hyperglycemia may worsen gastric
emptying27,31,57-59.In tube fed children with
neuromuscular disorders delayed gastric emptying has been reported. The
children with DMA, the delay reported to be related to gastric smooth
muscle involvement60,61. Also delayed gastric emptying
reported in patients with SMA type 162. In enterally
fed children diagnosed mitochondrial disease gastric delay impairment
was reported63.
Gastric decompression should be performed via nasogastric tube or
gastrostomy tube. If it doesn’t resolve a jejunal tube placement or
total parenteral nutrition can be considered to achieve
feeding31. Small volume, frequent, low-fat and low
fiber content feeding may be given in stable
patients58. The gastric emptying is significantly
faster with whey based formula compared to casein based
formula64. The use of prokinetic drugs such as
erythromycin, domperidone, cisapride and metoclopramide is contraversial
because of their serious side effects and conflicting
efficiacy58.