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Gastrointestinal Failure in Critically Ill Patients With Cirrhosis

Alukal, Joseph J. MD1; Thuluvath, Paul J. MD, FRCP1

American Journal of Gastroenterology: August 2019 - Volume 114 - Issue 8 - p 1231–1237
doi: 10.14309/ajg.0000000000000226

Gastrointestinal failure (GIF) is frequent in patients managed in the intensive care units and manifests as gut paralysis or ileus. GIF is often associated with sepsis or multiorgan failure. In critically ill patients, the precipitating causes of GIF include inflammation, sepsis, electrolyte abnormalities, and acidosis. It is possible that GIF is associated with an increase in bacterial translocation, especially in those with cirrhosis and portal hypertension, and this may play a significant pathogenic or prognostic role in acute-on-chronic liver failure (ACLF). The critical care literature suggests that GIF is associated with a higher mortality risk. In this review, we summarize the evidence for a potential association between GIF and ACLF and propose treatment options for the management of GIF. Moreover, we suggest GIF to be considered as another organ failure when the severity of ACLF is assessed.

1Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, Maryland, USA.

Correspondence: Paul J. Thuluvath, MD, FRCP. E-mail:

Received November 04, 2018

Accepted March 04, 2019

Online date: April 05, 2019

© The American College of Gastroenterology 2019. All Rights Reserved.
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