Erythromycin

Intensive care medicine

Metoclopramide

Biology

Stomach

Neostigmine

Vomiting

Anesthesia

Drug

Pathophysiology

Antibiotics

Microbiology

Internal medicine

Pharmacology

Gastric emptying

Medicine

Gastroenterology

Ileus

Parenteral nutrition

Irritable bowel syndrome

Gastroparesis

Enteral administration

Nutrition in Clinical Practice

Gastrointestinal dysmotility causes delayed gastric emptying, enteral feed intolerance, and functional obstruction of the small and large intestine, the latter functional obstructions being frequently termed ileus and Ogilvie syndrome, respectively. In addition to meticulous supportive care, drug therapy may be appropriate in certain situations. There is, however, considerable variation among individuals regarding what gastric residual volume identifies gastric dysmotility and would encourage use of a promotility drug. While the administration of either metoclopramide or erythromycin is supported by evidence it appears that, dual‐drug therapy (erythromycin and metoclopramide) reduces the rate of treatment failure. There is a lack of evidence to guide drug therapy of ileus, but neither erythromycin nor metoclopramide appear to have a role. Several drugs, including ghrelin agonists, highly selective 5‐hydroxytryptamine receptor agonists, and opiate antagonists are being studied in clinical trials. Neostigmine, when infused at a relatively slow rate in patients receiving continuous hemodynamic monitoring, may alleviate the need for endoscopic decompression in some patients.

Pathophysiology and Treatment of Gastrointestinal Motility Disorders in the Acutely Ill