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Anesth Analg 2005;100:1447-1452
© 2005 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000148688.30121.C0

CRITICAL CARE AND TRAUMA

The Relationship Between a Pentagastrin-Stimulated Gastric Luminal Acid Production Test (Gastrotest) and Enteral Feeding-Related Gastrointestinal Complications in Critically Ill Patients

Mark A. Hamilton, MRCP, FRCA*, Miriam V. Chapman, MRCP, FRCA*, Maj Mutch, RGN*, Elliott Bennett-Guerrero, MD{ddagger}, and Monty G. Mythen, MD, FRCA*{dagger}

*Centre for Anaesthesia, University College London; {dagger}Department of Anaesthesia and Critical Care, Institute of Child Health, University College London, London, United Kingdom; and {ddagger}Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina

Address correspondence and reprint requests to Elliott Bennett-Guerrero, MD, Duke Clinical Research Institute, Duke University (Anesthesiology-Box 3094), Durham, NC 27710. Address e-mail to benne011{at}mc.duke.edu.

Gastrointestinal feeding-related complications (GICs) are common in critically ill patients. Unfortunately, patients at risk for GICs cannot be easily identified. Therefore, we performed a prospective study of 20 critically ill patients to determine the association between a pentagastrin-stimulated gastric acid production test and GICs. Before feeding, the change in the pH of gastric juice was measured in response to a subcutaneous injection of pentagastrin (Gastrotest). We recorded GICs and the feeding volume ratio during each patient’s intensive care unit (ICU) stay. Nineteen patients’ data were analyzed and 9 patients (47%) developed ≥1 GIC, including large gastric residuals, 26%; abdominal distension, 26%; and vomiting, 21%. Patients with GICs had a longer length of ICU stay (mean 21.3, range 5–45 versus 10.1, range 3–32; P < 0.05). The 9 patients (47%) who were Gastrotest responders before starting enteral feeding exhibited a significantly larger volume ratio (P = 0.01) and fewer GICs (1 [11%] versus 8 [80%]; P < 0.05). Abdominal distension was seen in only nonresponders. The positive and negative predictive values for this test’s ability to predict GICs were 80% and 88.9%, respectively. Responding to a pentagastrin-stimulated gastric luminal acid production test is associated with the administration of larger volumes of enteral feed and fewer GICs.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2005 by the International Anesthesia Research Society.