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Antro-pyloro-duodenal motor responses to gastric and duodenal nutrient in critically ill patients
  1. M Chapman1,
  2. R Fraser2,
  3. R Vozzo3,
  4. L Bryant3,
  5. W Tam4,
  6. N Nguyen5,
  7. B Zacharakis6,
  8. R Butler6,
  9. G Davidson6,
  10. M Horowitz7
  1. 1Intensive Care Unit, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
  2. 2Department of Gastroenterology, Repatriation General Hospital, Adelaide, Australia
  3. 3Department of Medicine, University of Adelaide, Adelaide Australia
  4. 4Department of Gastroenterology, Royal Adelaide Hospital, Adelaide Australia
  5. 5Department of Gastroenterology, University of Adelaide, Adelaide, Australia
  6. 6Department of Gastroenterology, Women’s and Children’s Hospital, Adelaide Australia
  7. 7Department of Medicine, Royal Adelaide Hospital, Adelaide, Australia
  1. Correspondence to:
    Dr M Chapman
    Intensive Care Unit, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia 5000, Australia;


Background: Gastric emptying is frequently delayed in critical illness which compromises the success of nasogastric nutrition. The underlying motor dysfunctions are poorly defined.

Aims: To characterise antro-pyloro-duodenal motility during fasting, and in response to gastric and duodenal nutrient, as well as to evaluate the relationship between gastric emptying and motility, in the critically ill.

Subjects: Fifteen mechanically ventilated patients from a mixed intensive care unit; 10 healthy volunteers.

Methods: Antro-pyloro-duodenal pressures were recorded during fasting, after intragastric administration (100 ml; 100 kcal), and during small intestinal infusion of liquid nutrient (6 hours; 1 kcal/min). Gastric emptying was measured using a 13C octanoate breath test.

Results: In healthy subjects, neither gastric nor small intestinal nutrient affected antro-pyloro-duodenal pressures. In patients, duodenal nutrient infusion reduced antral activity compared with both fasting and healthy subjects (0.03 (0–2.47) waves/min v 0.14 (0–2.2) fasting (p = 0.016); and v 0.33 (0–2.57)/min in healthy subjects (p = 0.005)). Basal pyloric pressure and the frequency of phasic pyloric pressure waves were increased in patients during duodenal nutrient infusion (3.12 (1.06) mm Hg; 0.98 (0.13)/min) compared with healthy subjects (−0.44 (1.25) mm Hg; p<0.02 after 120 minutes; 0.29 (0.15)/min; p = 0.0002) and with fasting (−0.06 (1.05) mm Hg; p<0.03 after 160 minutes; 0.49 (0.13)/min; (p = 0.0001). Gastric emptying was delayed in patients (gastric emptying coefficient 2.99 (0.2) v 3.47 (0.1); p = 0.015) and inversely related to the number of pyloric pressure waves (r = −0.563, p = 0.029).

Conclusions: Stimulation of pyloric and suppression of antral pressures by duodenal nutrient are enhanced in the critically ill and related to decreased gastric emptying.

  • GEC, gastric emptying coefficient
  • APD, antro-pyloro-duodenal
  • TMPD, transmucosal potential difference
  • IPPWs, isolated pyloric pressure waves
  • MMC, migrating motor complex
  • ICU, intensive care unit
  • manometry
  • gastrointestinal motility
  • pylorus
  • critical illness
  • gastric emptying

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  • Conflict of interest: None declared.

  • Published online first 29 May 2005

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