title: The relationship between a pentagastrin-stimulated gastric luminal acid production test (Gastrotest) and enteral feeding-related gastrointestinal complications in critically ill patients.
abstract: Gastrointestinal feeding-related complications (GICs) are common in critically ill patients. Unfortunately, patients at risk for GICs cannot be easily identified. Therefore, we performed a prospective study of 20 critically ill patients to determine the association between a pentagastrin-stimulated gastric acid production test and GICs. Before feeding, the change in the pH of gastric juice was measured in response to a subcutaneous injection of pentagastrin (Gastrotest). We recorded GICs and the feeding volume ratio during each patient's intensive care unit (ICU) stay. Nineteen patients' data were analyzed and 9 patients (47%) developed > or =1 GIC, including large gastric residuals, 26%; abdominal distension, 26%; and vomiting, 21%. Patients with GICs had a longer length of ICU stay (mean 21.3, range 5-45 versus 10.1, range 3-32; P < 0.05). The 9 patients (47%) who were Gastrotest responders before starting enteral feeding exhibited a significantly larger volume ratio (P = 0.01) and fewer GICs (1 [11%] versus 8 [80%]; P < 0.05). Abdominal distension was seen in only nonresponders. The positive and negative predictive values for this test's ability to predict GICs were 80% and 88.9%, respectively. Responding to a pentagastrin-stimulated gastric luminal acid production test is associated with the administration of larger volumes of enteral feed and fewer GICs.
authors.affiliation: *Centre for Anaesthesia, University College London; †Department of Anaesthesia and Critical Care, Institute of Child Health, University College London, London, United Kingdom; and ‡Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Hamilton
authors.forename: Miriam V
authors.initials: MV
authors.lastname: Chapman
authors.forename: Maj
authors.initials: M
authors.lastname: Mutch
authors.forename: Elliott
authors.initials: E
authors.lastname: Bennett-Guerrero
authors.forename: Monty G
authors.initials: MG
authors.lastname: Mythen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D005744:Gastric Acid / Q000378:metabolism*; D005767:Gastrointestinal Diseases / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010418:Pentagastrin / Q000494:pharmacology*; D011446:Prospective Studies
chemical_list: D010418:Pentagastrin