Abstract:
Background:
Gastrointestinal dysfunction (GDF) is experienced by majority of surgical patients. Enteral
feeding (EF) can induce and exacerbate GDF. Current tools for assessing gut function are
subjective and not reliable. The aims were to review the potential role of gut biomarkers to
assess GDF, determine whether EF alters gastric electrophysiology, and evaluate intraluminal
pressure (ILP) and gastric electrophysiology in postoperative patients on EF.
Methods:
Three studies were conducted.
1. Systematic literature review to explore the association between gut biomarkers in the blood
and GDF in surgical and acute patients.
2. Prospective study of healthy volunteers to determine whether body surface gastric mapping
(BSGM) of gastric electrophysiology (using the Alimetry system) can detect changes due to
EF (mimicked by ‘sip feeding’).
3. First-in-human prospective clinical study was conducted to determine the feasibility of using
two objective methods for GDF in post-operative patients over a 6-8 hour period. ILP was
measured through the column of feed. Gastric slow wave electrophysiology was recorded by
BSGM. Clinical symptoms were also recorded.
Results:
1. There is insufficient data to recommend gut bio-markers for assessing GDF.
2. Sip feeding resulted in a definite and consistent slow wave response with BSGM.
3. Both ILP and BSGM have potential to improve the prediction, diagnosis and monitoring of
GDF.
Conclusion:
The current approaches to the assessment of GDF are subjective. The current evidence base for
the use of gut biomarkers is poor and no recommendations can be made for incorporating them
into the assessment of GDF. Better quality studies are required. The volunteer study
demonstrated that it is possible to detect a signature response to EF by BSGM. The clinical
study demonstrated that it is feasible to measure both ILP and BSGM in postoperative patients
and provided sufficient evidence to justify more definitive studies. All three studies have
highlighted the potential to improve the assessment of GDF, using objectives measures,
including but biomarkers, ILP and BSGM