Altered GI Motility in Critically Ill Patients: Current Understanding of Pathophysiology, Clinical Impact, and Diagnostic Approach

Gastrointestinal (GI) motility disturbances are common in critically ill patients. GI tract dysmotility has been linked to increased permeability of intestinal mucosa and bacterial translocation, contributing to systemic inflammatory response syndrome, sepsis, and multiple organ dysfunction syndrome. A key issue in providing nutrition to critically ill patients is intolerance of enteral feeding as a result of impaired GI motility. Remarkable progress has been made in the understanding of the regulation of GI motility in critical illness. Predominant motility abnormalities seen in ICU patients include antral hypomotility, delayed gastric emptying, and reduced migrating motor complexes. The diagnosis of motility disturbances can be challenging to establish in critically ill patients. The available tests used for detection of abnormal motility have major limitations in the ICU setting. Recognition of the type and site of intestinal motility disorder is important to guide the therapy and improve the outcome. (Nutr Clin Pract. 2010;25:16-25.)