Reversal of feed intolerance by prokinetics improves survival in critically ill cirrhosis patients
Open accessAbstract
Background and aims Feed intolerance (FI) is common in cirrhosis patients in intensive care units (ICU). Prokinetics are the first line treatment for FI but their efficacy and safety in critically ill patient with cirrhosis is unknown. We evaluated the role of prokinetics in reversal of FI and clinical outcomes. Methods Consecutive patients admitted in ICU developing new-onset FI, were randomized to receive either intravenous metoclopramide (Gr.A, n = 28), erythromycin (Gr.B, n = 27) or placebo (Gr.C, n = 28). FI was defined with the presence of 3 of 5 variables- absence of bowel sounds, gastric residual volume ≥ 500 ml, vomiting, diarrhoea and bowel distension. Primary end-point was complete resolution of FI (≥ 3 variables resolved) within 24-h and secondary end-points included resolution within 72-h and survival at 7-days. Results Of the 1030 ICU patients, 201 (19.5%) developed FI and 83 patients were randomized. Baseline parameters between the groups were comparable. Complete resolution at 24-h was higher in Gr.A (7.14%) and B (22.2%) than C (0%, p = 0.017). Overall, 58 (69.9%) patients achieved resolution within 72 h, more with metoclopramide (n = 24, 85.7%) and erythromycin (n = 25, 92.6%) than with placebo (n = 9, 32.1%, p < 0.001). The 7-day survival was better in patients who achieved resolution within 72-h (65.5 vs. 36%, p = 0.011) than non-responders. High lactate (OR-3.32, CI-1.45-7.70, p = 0.005), shock at baseline (OR-6.34, CI-1.67-24.1, p = 0.007) and resolution of FI within 72 h (OR-0.11, CI, 0.03-0.51, p = 0.04) predicted 7-day mortality. Conclusions FI is common in critically-ill cirrhosis patients and non-resolution carries high mortality. Early recognition and treatment with prokinetics is recommended to improve short-term survival.
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A better survival was observed in patients in whom EFI was resolved within 72 h, more likely in patients receiving prokinetics.
“A better survival was observed in patients in whom EFI was resolved within 72 h, more likely in patients receiving prokinetics [38].”
From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [38]
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ESPEN guideline on clinical nutrition in the intensive care unit.
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Sorted by citations
ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit
Singer, P., Blaser, A. R., Berger, M. M., Calder, P. C., Casaer, M., Hiesmayr, M., Mayer, K., Montejo-Gonzalez, J. C., Pichard, C., Preiser, J.-C., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.07.011 · Cited by 793 · see citing works
- Authors
- Vijayaraghavan, R., Maiwall, R., Arora, V., Choudhary, A., Benjamin, J., Aggarwal, P., Jamwal, K. D., Kumar, G., Joshi, Y. K., & Sarin, S. K.
- Affiliations
- Institute of Liver and Biliary Sciences (IN)
- Artemis Hospitals (IN)
- Corresponding author
- Sarin, Shiv K.
- Venue
- Digestive Diseases and Sciences
- Published
- 2021-08-14
- Volume
- 67
- Issue
- 8
- Pages
- 4223-4233
- ISSN
- 0163-2116 (ISSN-L)
- 1573-2568
- PMC
- PMC8364303
- OpenAlex
- W3194813782
- Cited by
- 15
- References
- 3
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 1 · 2023: 3 · 2022: 2
- FWCI
- 0.83
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Digestive Diseases and Sciences (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- feeding intolerance, prokinetic agents, metoclopramide, erythromycin, liver cirrhosis, critically ill patients, intensive care, survival, gastric residual volume, lactate, shock, mortality prediction, gastric emptying, vomiting, diarrhea, bowel distension, mortality risk factors, prognostic factors
- MeSH terms
- Enteral Nutrition, Erythromycin, Humans, Intensive Care Units, Liver Cirrhosis, Metoclopramide, Critical Illness
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