title: Review article: the role of gastrointestinal hormones in the treatment of delayed gastric emptying in critically ill patients.
abstract: BACKGROUND
  Delayed gastric emptying limits the administration of enteral nutrition, leading to malnutrition, which is associated with higher mortality and morbidity. Currently available prokinetics have limitations in terms of sustained efficacy and side effects.
  
  
  OBJECTIVE
  To summarise the mechanisms of action and to discuss the possible utility of gastrointestinal hormones to prevent or treat delayed gastric emptying in critically ill patients.
  
  
  METHODS
  We searched PubMed for articles discussing 'delayed gastric emptying', 'enteral nutrition', 'treatment', 'gastrointestinal hormones', 'prokinetic', 'agonist', 'antagonist' and 'critically ill patients'.
  
  
  RESULTS
  Motilin and ghrelin receptor agonists initiate the migrating motor complex in the stomach, which accelerates gastric emptying. Cholecystokinin, glucagon-like peptide-1 and peptide YY have an inhibiting effect on gastric emptying; therefore, antagonising these gastrointestinal hormones may have therapeutic potential. Other gastrointestinal hormones appear less promising.
  
  
  CONCLUSIONS
  Manipulation of endogenous secretion, physiological replacement and administration of gastrointestinal hormones in pharmacological doses is likely to have therapeutic potential in the treatment of delayed gastric emptying. Future challenges in this field will include the search for candidates with improved selectivity and favourable kinetic properties.
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands. j.luttikhold@vumc.nl
authors.forename: J
authors.initials: J
authors.lastname: Luttikhold
authors.forename: F M
authors.initials: FM
authors.lastname: de Ruijter
authors.forename: K
authors.initials: K
authors.lastname: van Norren
authors.forename: M
authors.initials: M
authors.lastname: Diamant
authors.forename: R F
authors.initials: RF
authors.lastname: Witkamp
authors.forename: P A M
authors.initials: PA
authors.lastname: van Leeuwen
authors.forename: M A R
authors.initials: MA
authors.lastname: Vermeulen
mesh_terms: D016638:Critical Illness; D004750:Enteral Nutrition / Q000379:methods; D005746:Gastric Emptying / Q000187:drug effects*; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D005768:Gastrointestinal Hormones / Q000502:physiology*; D018589:Gastroparesis / Q000188:drug therapy; D006801:Humans; D044342:Malnutrition / Q000517:prevention & control; D013997:Time Factors
chemical_list: D005765:Gastrointestinal Agents; D005768:Gastrointestinal Hormones