title: Gastrointestinal failure in the ICU.
abstract: OBJECTIVE
  The current review summarizes different aspects of assessment of gastrointestinal function and provides a practical approach to management of adult patients with gastrointestinal dysfunction in the ICU.
  
  
  RESULTS
  Different ways to define gastrointestinal failure have been used in the past. Recently, the term 'acute gastrointestinal injury (AGI)' has been proposed to specifically describe gastrointestinal dysfunction as a part of multiple organ dysfunction syndrome. Possible pathophysiological mechanisms and different aspects in assessment of gastrointestinal function in adult ICU patients are presented. Currently, there is no single marker that could reliably describe gastrointestinal dysfunction. Therefore, monitoring and management is still based on complex assessment of different gastrointestinal symptoms and feeding intolerance, even though this approach includes a large amount of subjectivity. The possible role of biomarkers (citrulline, enterohormones, etc.) and additional parameters like intra-abdominal pressure remains to be clarified.
  
  
  CONCLUSIONS
  Defining gastrointestinal failure remains challenging but broad consensus needs to be reached and disseminated soon to allow conduct of interventional studies. A systematic approach to management of gastrointestinal problems is recommended.
authors.affiliation: aDepartment of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland bDepartment of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia cDepartment of Intensive Care Medicine, University Hospital of Bern, University of Bern, Bern, Switzerland dDepartment of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia.
authors.forename: Annika
authors.initials: A
authors.lastname: Reintam Blaser
authors.forename: Stephan M
authors.initials: SM
authors.lastname: Jakob
authors.forename: Joel
authors.initials: J
authors.lastname: Starkopf
mesh_terms: D000328:Adult; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index