NUTRITION AND THE INTENSIVE CARE UNIT: Edited by Mette Berger and Jeffrey I. MechanickGastrointestinal dysmotility evidence and clinical managementChapman, Marianne J.a,b; Nguyen, Nam Q.c,d; Deane, Adam M.a,b Author Information aDepartment of Critical Care Services, Royal Adelaide Hospital bDiscipline of Acute Care Medicine, School of Medicine, University of Adelaide cDepartment of Gastroenterology and Hepatology, Royal Adelaide Hospital dDiscipline of Medicine, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia Correspondence to Marianne J. Chapman, Intensive Care Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia. Tel: +61 41 218 3894; fax: +61 88 222 2367; e-mail: [email protected] Current Opinion in Clinical Nutrition and Metabolic Care: March 2013 - Volume 16 - Issue 2 - p 209-216 doi: 10.1097/MCO.0b013e32835c1fa5 Buy Metrics Abstract Purpose of review Gastrointestinal dysmotility and dysfunction underlie our difficulties in providing adequate nutrition by the enteral route to our critically ill patients. Recent findings Recent studies have quantified gastric emptying and nutrient absorption. Slow gastric emptying is common and probably mediated by cholecystokinin and reduced active ghrelin concentrations. The cause of impaired nutrient absorption is not yet fully understood but may be related to small intestinal blood flow and/or mucosal factors. The absorption of the different macronutrients may be affected in different ways both by critical illness and by therapies. A better understanding of this may optimize the design of nutrient formulations in the future. New treatment modalities for gastrointestinal dysfunction are being investigated and include small intestinal feeding, nonpharmacological options such as acupuncture, and drugs including novel motilin receptor agonists, and opioid antagonists. Summary We are gradually developing a better understanding of how the gut works during critical illness, which has implications for optimizing the delivery of nutrition and thereby improving nutritional and clinical outcomes. © 2013 Lippincott Williams & Wilkins, Inc.