Amylin is associated with delayed gastric emptying in critically ill children

Objectives: Amylin is a novel 37 amino acid that is secreted together,with insulin from the pancreas in response to enteral nutrient intake. As a potent inhibitor of gastric motility it plays an important role in the control of carbohydrate absorption. In this study we aimed to determine the relationship between amylin levels and gastric emptying in critically ill children. Design: Prospective interventional study. Setting: Tertiary paediatric intensive care unit. Patients: Twenty-three patients were studied following admission to a paediatric intensive care unit. The median age (25(th)-75(th) centiles) was 5.8 years (1.5-11.6) and weight 20 kg (12.8-47.5). Interventions: Patients were defined as feed-intolerant on the basis of gastric residual volume greater than 125% 4 h after a feed challenge. Three objective measures of gastric emptying were then calculated from a 6 h paracetamol absorption test. Blood glucose, serum insulin and amylin levels were averaged across the paracetamol absorption test period. Measurements and results: Eight patients were classified as feed-intolerant (nTOL) and 15 as feed-tolerant (TOL) [median gastric residual volumes 321% (261-495) and 4% (0-6), respectively]. Gastric emptying was delayed in the feed-intolerant group as assessed by all paracetamol absorption test parameters (pless than or equal to0.01). The median serum amylin concentration was significantly higher in the feed-intolerant group [nTOL 47.0 (37.7-54.8) versus TOL 22.7 (13.6-26.7) pmol/l, p<0.0001]. A positive correlation between serum amylin and insulin was observed (r=0.46, p=0.021) but not between amylin and glucose (r=0.25, p=0.23). Conclusions: The use of gastric residual volumes to define feed intolerance is justified in critically ill children. High serum amylin levels are associated with delayed gastric emptying in these patients. The correlation between serum amylin and insulin levels indicates a degree of preservation of pancreatic hormonal co-release.