Gastroparesis of the Critically Ill Patient - An Underestimated Problem?

Intestinal motility disturbances - like gastroparesis - worsen the outcome of critically ill patients. Inadequate and delayed feeding as well as micro aspiration, pneumonia and systemic infections up to sepsis and multiple organ failure have to be mentioned. Especially in milder cases and in the beginning symptoms are unspecific and diffuse. On the other hand the awareness of physicians has not been raised sufficiently; both problems are responsible for a lower number of patients diagnosed than affected. Especially in critically ill patients it is reasonable to distinguish between a temporary and a permanent gastroparesis. In patients with permanent gastroparesis we distinguish between three grades of severity. The most important therapeutic option is to adapt enteral nutrition according to the delay in gastric emptying. Four to six fluid-dominated, low fat and low fiber meals should be preferred in patients who eat by themselves, in intubated patients enteral nutrition should be started with lower rates, and increased more slowly. Prokinetic and antiemetic drugs complete the therapeutic options we have in critically ill patients.