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Critical care dysmotility: abnormal foregut motor function in the ICU/ITU patient
  1. E M M Quigley
  1. Correspondence to:
    Professor E M M Quigley
    Alimentary Pharmabiotic Centre, Department of Medicine, Clinical Sciences Building, Cork University Hospital, Cork, Ireland;

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While aspiration and feeding difficulties are well known challenges in the intensive care unit, their pathophysiology has been poorly understood. New information suggests that the critically ill are subject to profound alterations in motor and sensory function of the oesophagus, lower oesophageal sphincter, stomach, and duodenum which go some way to explaining their propensity to reflux and gastroparesis, with their attendant risks

As medicine changes so should all aspects of medical care and knowledge; as more and more patients are subjected to surgical procedures of increasing complexity and risk and as survival rates from catastrophic illness rise, due to advances in surgery, anaesthesia, and intensive care, one would expect an associated growth in awareness of, and research into, the effects of critical illness on gut motor function. However, motor function and dysfunction, in this context, have received scant attention and have remained, for the most part, poorly understood. While a high prevalence of such phenomena as gastro-oesophageal reflux and gastroparesis are assumed, their true rates of occurrence have been scarcely documented. Similarly, while potential consequences of these entities, such as aspiration, oesophagitis, nosocomial pneumonia, feeding difficulties, and even gastric perforation are well known and, justifiably, feared, the effects of critical illness on oesophageal and gastric motor function have been little investigated. There are, it must be conceded, many reasons for this. Several factors, intrinsic to any intensive care (or therapy) unit (IC/TU) patient population, deter the clinician-scientist from embarking on the investigation of these subjects and confound the interpretation of any studies completed.

First and foremost, this is, by definition, a heterogeneous population. Depending on the nature of a particular unit, it may include among its patients a wide range of ages as well as a diverse catalogue of precipitating illnesses and events. Among the latter, prior surgery, raised intracranial …

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  • Conflict of interest: None declared.

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