Show Summary Details
Page of

Gastrointestinal motility drugs in critical illness 

Gastrointestinal motility drugs in critical illness
Chapter:
Gastrointestinal motility drugs in critical illness
Author(s):

Sonja Fruhwald

and Peter Holzer

DOI:
10.1093/med/9780199600830.003.0040
Page of

PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2020. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy and Legal Notice).

date: 22 February 2020

Gastrointestinal motility disturbances in critically-ill patients often require treatment with prokinetic drugs. The aetiology of motility disturbances is complex, and involves electrolyte imbalances, hypervolaemia, reduced intestinal secretion, adverse effects of drugs (catecholamines, opioids, or sedatives) and disease- or treatment-related changes of microflora. However, the choice of prokinetics is narrow, and the multiplicity of pathophysiological mechanisms often limits their efficacy. Gastroparesis can be managed with gastrokinetics such as domperidone, metoclopramide and erythromycin. Their choice depends not only on efficacy, but also on adverse effect profile. The arrhythmogenic potential of domperidone limits maximum daily dose and treatment duration. Metoclopramide and erythromycin induce tachyphylaxis, which restricts treatment duration. The combination of metoclopramide and erythromycin serves as rescue therapy in severe gastroparesis. Neostigmine and laxatives are used to manage colonic paralysis, and these treatment options may eventually be extended by drug candidates, such as prucalopride, lubiprostone, and linaclotide, whose utility in the ICU awaits to be evaluated. Neostigmine’s prokinetic efficacy in colonic paralysis is limited, but well documented in patients with acute colonic pseudo-obstruction (Ogilvie syndrome). Care is advocated in dosing because higher doses of neostigmine inhibit motility. Alternative options include osmotic and stimulant laxatives, especially for prophylactic use. The opioid receptor antagonist alvimopan is used for the short-term management of post-operative ileus, while methylnaltrexone is indicated in palliative care and chronic pain management. Since its efficacy in critically-ill patients remains to be proven, the use of methylnaltrexone in the ICU is off-label and requires proper documentation.

Access to the complete content on Oxford Medicine Online requires a subscription or purchase. Public users are able to search the site and view the abstracts for each book and chapter without a subscription.

Please subscribe or login to access full text content.

If you have purchased a print title that contains an access token, please see the token for information about how to register your code.

For questions on access or troubleshooting, please check our FAQs, and if you can't find the answer there, please contact us.