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Type: Journal article
Title: Bench-to-bedside review: The gut as an endocrine organ in the critically ill
Author: Deane, A.
Chapman, M.
Fraser, R.
Horowitz, M.
Citation: Critical Care (UK), 2010; 14(5):1-10
Publisher: Current Science Ltd
Issue Date: 2010
ISSN: 1466-609X
Statement of
Adam Deane, Marianne J Chapman, Robert JL Fraser, and Michael Horowitz
Abstract: In health, hormones secreted from the gastrointestinal tract have an important role in regulating gastrointestinal motility, glucose metabolism and immune function. Recent studies in the critically ill have established that the secretion of a number of these hormones is abnormal, which probably contributes to disordered gastrointestinal and metabolic function. Furthermore, manipulation of endogenous secretion, physiological replacement and supra-physiological treatment (pharmacological dosing) of these hormones are likely to be novel therapeutic targets in this group. Fasting ghrelin concentrations are reduced in the early phase of critical illness, and exogenous ghrelin is a potential therapy that could be used to accelerate gastric emptying and/or stimulate appetite. Motilin agonists, such as erythromycin, are effective gastrokinetic drugs in the critically ill. Cholecystokinin and peptide YY concentrations are elevated in both the fasting and postprandial states, and are likely to contribute to slow gastric emptying. Accordingly, there is a rationale for the therapeutic use of their antagonists. So-called incretin therapies (glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide) warrant evaluation in the management of hyperglycaemia in the critically ill. Exogenous glucagon-like peptide-2 (or its analogues) may be a potential therapy because of its intestinotropic properties.
Keywords: Gastrointestinal Tract
Endocrine System
Critical Illness
Peptide YY
Blood Glucose
Intestinal Absorption
Point-of-Care Systems
Description: Review
Rights: © 2010 BioMed Central Ltd
DOI: 10.1186/cc9039
Appears in Collections:Anaesthesia and Intensive Care publications
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