Use of prokinetic agents in hospitalised adult patients: A scoping review
Open accessAbstract
Background: Gastrointestinal motility is important for adequate uptake of fluids and nutrition but is often impaired in hospitalised patients. Prokinetic agents enhance gastrointestinal motility and are prescribed for many hospitalised patients. In this scoping review, we aimed to systematically describe the body of evidence on the use of prokinetic agents in hospitalised patients. We hypothesised, that the body of evidence would be limited and derive from heterogeneous populations. Methods: We conducted this scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews statement. We searched Medline, Embase, Epistemonikos and the Cochrane Library for studies assessing the use of prokinetic agents on any indication and outcome in adult hospitalised patients. We used a modified version of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the certainty of evidence. Results: We included 102 studies with a total of 8830 patients. Eighty‐six studies were clinical trials (84%), and 52 (60%) of these were conducted in the intensive care unit, with feeding intolerance as the main indication. In the non‐intensive care setting the indications were wider; most studies assessed use of prokinetic agents before gastroscopy to improve visualisation. The most studied prokinetic agent was metoclopramide (49% of studies) followed by erythromycin (31%). In total 147 outcomes were assessed with only 67% of the included studies assessing patient‐centred outcomes, and with gastric emptying as the most frequently reported outcome. Overall, the data provided no firm evidence on the balance between the desirable and undesirable effects of prokinetic agents. Conclusions: In this scoping review, we found that the studies addressing prokinetic agents in hospitalised adults had considerable variations in indications, drugs and outcomes assessed, and that the certainty of evidence was judged to be low to very low.
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In many studies, enteral feeding intolerance is not uniformly defined and refers solely to the upper gastrointestinal tract (gastroparesis).
“In many studies, EFI is not uniformly defined and refers solely to the upper GI tract (gastroparesis) [51].”
From Gastrointestinal function and nutritional interventions in septic shock (2025) · cites this paper as [51]
It has not been convincingly shown that interventions currently used to manage enteral feeding intolerance, such as prokinetics, laxatives, or postpyloric enteral nutrition, improve patient-relevant outcomes.
“Importantly, it has not been convincingly shown that any interventions currently used to manage EFI (prokinetics, laxatives, postpyloric EN) may improve patient-relevant outcomes [51,52].”
From Gastrointestinal function and nutritional interventions in septic shock (2025) · cites this paper as [51]
Cites
PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation
Tricco, A. C., Lillie, E., Zarin, W., O'Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Horsley, T., Weeks, L., et al. (2018) · Annals of Internal Medicine · doi:10.7326/m18-0850 · Cited by 43,565 · see citing works
ESPEN guideline on clinical nutrition in the intensive care unit.
Singer, P., Blaser, A. R., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, M. P., Hiesmayr, M., Mayer, K., Montejo, J. C., Pichard, C., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.08.037 · Cited by 2,904 · cited 2× · see citing works
“It has previously been described that treatment with erythromycin for 2–4 days is significantly associated with better enteral feeding tolerance.(118) However, treatment with prokinetic agents in general”
BackgroundSelf-citationErythromycin improves gastric emptying in critically ill patients intolerant of nasogastric feeding
Chapman, M. J., Fraser, R. J., Kluger, M. T., Buist, M. D., & De Nichilo, D. J. (2000) · Critical Care Medicine · doi:10.1097/00003246-200007000-00026 · Cited by 163 · see citing works
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Self-citationYavagal, D. R., Karnad, D. R., & Oak, J. L. (2000) · Critical Care Medicine · doi:10.1097/00003246-200005000-00025 · Cited by 123 · see citing works
Erythromycin and early enteral nutrition in mechanically ventilated patients
Reignier, J., Bensaid, S., Perrin-Gachadoat, D., Burdin, M., Boiteau, R., & Tenaillon, A. (2002) · Critical Care Medicine · doi:10.1097/00003246-200206000-00012 · Cited by 101 · see citing works
Nassaji, M., Ghorbani, R., Frozeshfard, M., & Mesbahian, F. (2010) · Eastern Mediterranean Health Journal · doi:10.26719/2010.16.4.371 · Cited by 17 · see citing works
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Gastrointestinal function and nutritional interventions in septic shock
Bachmann, K. F., Cotoia, A., & Reintam Blaser, A. (2025) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000001302 · Cited by 13 · see citing works
- Authors
- Crone, V., Møller, M. H., Bækgaard, E. S., Perner, A., Bytzer, P., Alhazzani, W., & Krag, M.
- Affiliations
- Holbæk Sygehus (DK)
- University of Copenhagen (DK)
- King Saud University (SA)
- Corresponding author
- Crone, Vera
- ORCID
- Venue
- Acta Anaesthesiologica Scandinavica
- Publisher
- Wiley
- Published
- 2023-03-08
- Volume
- 67
- Issue
- 5
- Pages
- 588-598
- ISSN
- 0001-5172 (ISSN-L)
- 1399-6576
- OpenAlex
- W4322495079
- Cited by
- 15
- References
- 7
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 2 · 2023: 1
- FWCI
- 0.88
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Acta Anaesthesiologica Scandinavica (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Keywords
- prokinetic agents, gastrointestinal motility, hospitalized adults, metoclopramide, erythromycin, feeding intolerance, gastric emptying, upper gastrointestinal endoscopy, intensive care unit, patient-centered outcomes, quality of evidence
- MeSH terms
- Adult, Erythromycin, Gastric Emptying, Humans, Infant, Newborn, Intensive Care Units, Metoclopramide
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