Dysfunction of upper gastrointestinal tract in critically ill patients: current view and prospects

Abstract

Acute gastrointestinal dysfunction being one of the aspects of multi-organ dysfunction syndrome in critically ill patients is a frequent problem in intensive care and is associated with high morbidity and mortality. In the upper gastrointestinal tract, the dysfunction is manifested as a stress-induced ulcer syndrome and a complex motility disorder leading to intolerance of gastric enteral nutrition and reflux esophagitis in duodenogastroesophageal reflux, with a high risk of aspiration and nosocomial pneumonia. The key pathogenetic mechanisms are (i) splanchnic hypoperfusion leading to breakdown of the barrier function of stomach mucosa that results in mucosal erosions and ulcers, (ii) weakening or loss of lower oesophageal sphincter tonus, and (iii) reduction and loss of effectiveness of prograde gastric evacuation. Complications of this gastrointestinal dysfunction can be reduced by routine support care for critically ill patients, such as basic hemodynamic stabilization, adequate tissue oxygenation, and, if possible, influencing the causal problem. In indicated cases of this dysfunction, prophylaxis of the stress-induced ulcers, prokinetics administration, and potential insertion of adouble-luminal probe suitable for both derivation and nutrition, to bypass the motility disorder of the upper gastrointestinal tract in the case of intolerance of gastric enteral nutrition, may be used in treatment.