title: Alternatives to prokinetics to move the pylorus and colon.
abstract: OBJECTIVE
  Gastrointestinal motility disorders (GMDs) are common in the ICU. When encountering these problems, one typically thinks of prokinetics. This review summarizes current evidence of treatments.
  
  
  RESULTS
  Prokinetics are not the first-line therapy for GMDs. In fact, the clinical implications of using prokinetic agents are rather controversial. Current evidence on alternative treatment modalities such as fluid and electrolyte management, laxatives, opioid antagonists, purgative enemas, acupuncture, physical therapies and probiotics is growing.
  
  
  CONCLUSIONS
  Current state of the art to treat GMDs is primarily focused at the elimination of underlying trigger factors. Fluid and electrolyte management as well as laxatives and peripherally acting μ-opioid receptor antagonists are the recommended first-line therapies that can be complemented with prokinetics. Acupuncture as well as physical modalities, such as massage or warming of the abdomen, is promising with few side-effects and should be considered as well.
authors.affiliation: Department of Preventive and Rehabilitative Sports Medicine, Technische Universität München, Munich, Germany. pfab@sport.med.tum.de
authors.forename: Florian
authors.initials: F
authors.lastname: Pfab
authors.forename: Martina
authors.initials: M
authors.lastname: Nowak-Machen
authors.forename: Vitaly
authors.initials: V
authors.lastname: Napadow
authors.forename: Johannes
authors.initials: J
authors.lastname: Fleckenstein
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods; D000818:Animals; D003106:Colon / Q000503:physiopathology*; D000529:Complementary Therapies / Q000379:methods*; D004733:Enema / Q000379:methods; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D005767:Gastrointestinal Diseases / Q000628:therapy*; D005769:Gastrointestinal Motility / Q000187:drug effects; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D009271:Naltrexone / Q000031:analogs & derivatives / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D010880:Piperidines / Q000627:therapeutic use; D019936:Probiotics / Q000627:therapeutic use; D011708:Pylorus / Q000503:physiopathology*; D000644:Quaternary Ammonium Compounds / Q000627:therapeutic use
chemical_list: D005765:Gastrointestinal Agents; D054368:Laxatives; D009292:Narcotic Antagonists; D010880:Piperidines; D000644:Quaternary Ammonium Compounds; C032257:methylnaltrexone; D009271:Naltrexone; C419502:alvimopan