BACKGROUND: Motility disorders of upper gastrointestinal tract are common in critical illness and associated with significant clinical consequences. However, detailed quantitative and qualitative analyses of esophageal motor functions are lacking. Therefore, we aimed to characterize the key features of esophageal motility functions using high-resolution impedance manometry (HRIM) and to evaluate an objective link between esophageal motor patterns, gastric emptying, and gastroesophageal reflux. We also studied the prokinetic effects of metoclopramide. METHODS: We prospectively performed HRIM for 16 critically ill hemodynamically stable patients. Patients were included if they had low gastric volume (LGV; < 100 mL/24 h, n = 8) or high gastric volume (HGV; > 500 mL/24 h, n = 8). The HRIM data were collected for 5 h with intravenous metoclopramide administration (10 mg) after the first 2 h. RESULTS: The findings were grossly abnormal for all critically ill patients. The esophageal contraction vigor was markedly increased, indicating prevailing hypercontractile esophagus. Ineffective propulsive force was observed for 73% of esophageal activities. Panesophageal pressurization was the most common pressurization pattern (64%). Gastroesophageal reflux predominantly occurred with transient lower esophageal sphincter relaxation. The common features of the LGV group were a hyperreactive pattern, esophagogastric outflow obstruction, and frequent reflux. Ineffective motility with reduced lower esophageal sphincter tone, and paradoxically fewer reflux episodes, was common in the HGV group. Metoclopramide administration reduced the number of esophageal activities but did not affect the number of reflux episodes in either group. CONCLUSION: All critically ill patients had major esophageal motility abnormalities, and motility patterns varied according to gastric emptying status. Well-preserved gastric emptying and maintained esophagogastric barrier functions did not eliminate reflux. Metoclopramide failed to reduce the number of reflux episodes regardless of gastric emptying status. Trial registration ISRCTN, ISRCTN14399966. Registered 3.9.2020, retrospectively registered. https://www.isrctn.com/ISRCTN14399966 .

Department of Internal Medicine Faculty of Medicine in Pilsen Pilsen University Hospital Charles University Prague Alej Svobody 80 30406 Pilsen Czech Republic

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Ladopoulos T, Giannaki M, Alexopoulou C, Proklou A, Pediaditis E, Kondili E. Gastrointestinal dysmotility in critically ill patients. Ann Gastroenterol. 2018 doi: 10.20524/aog.2018.0250. PubMed DOI PMC

Kolbel CB, Rippel K, Klar H, Singer MV, Van AK, Fiedler F. Esophageal motility disorders in critically ill patients: a 24-hour manometric study. Intensive Care Med. 2000 doi: 10.1007/s001340000630. PubMed DOI

Nind G, Chen WH, Protheroe R, Iwakiri K, Fraser R, Young R, Chapman M, Nguyen N, Sifrim D, Rigda R, Holloway RH. Mechanisms of gastroesophageal reflux in critically ill mechanically ventilated patients. Gastroenterology. 2005 doi: 10.1053/j.gastro.2004.12.034. PubMed DOI

Savarino E, Marabotto E, Bodini G, Furnari M, Della CM, Ghisa M, Barberio B, Frazzoni M, De BN, Zentilin P, Pellegatta G, Tolone S, Ottonello A, Savarino V. Advancements in the use of manometry and impedance testing for esophageal functional disorders. Expert Rev Gastroenterol Hepatol. 2019 doi: 10.1080/17474124.2019.1595587. PubMed DOI

Schar MS, Omari TI, Fraser RJ, Bersten AD, Bihari S. Disordered swallowing associated with prolonged oral endotracheal intubation in critical illness. Intensive Care Med. 2020 doi: 10.1007/s00134-018-5181-1. PubMed DOI

Persson P, Ahlstrand R, Gudmundsson M, De LA, Lundin S. Detailed measurements of oesophageal pressure during mechanical ventilation with an advanced high-resolution manometry catheter. Crit Care. 2019 doi: 10.1186/s13054-019-2484-8. PubMed DOI PMC

Ahlstrand R, Thörn S-E, Wattwil M. High-resolution solid-state manometry of the effect of rocuronium on barrierpressure. Acta Anaesthesiol Scand. 2011 doi: 10.1111/j.1399-6576.2011.02517.x. PubMed DOI

Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, Pandolfino JE, International High Resolution Manometry Working Group The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015 doi: 10.1111/nmo.12477. PubMed DOI PMC

van Hoeij FB, Bredenoord AJ. Clinical application of esophageal high-resolution manometry in the diagnosis of esophageal motility disorders. J Neurogastroenterol Motil. 2016 doi: 10.5056/jnm15177. PubMed DOI PMC

Heyland DK, Marquis F, Lamontagne F, Albert M, Turgeon AF, Khwaja KA, Garland A, Hall R, Chapman MG, Kutsiogannis DJ, Martin C, Sessler DI, Day AG. Promotion of regular oesophageal motility to prevent regurgitation and enhance nutrition intake in long-stay ICU patients. A Multicenter, Phase II, Sham-Controlled, Randomized Trial: The PROPEL Study. Crit Care Med. 2020 doi: 10.1097/CCM.0000000000004176. PubMed DOI

Fruhwald S, Holzer P, Metzler H. Intestinal motility disturbances in intensive care patients pathogenesis and clinical impact. Intensive Care Med. 2007 doi: 10.1007/s00134-006-0452-7. PubMed DOI

He S, Jell A, Hüser N, Kohn N, Feussner H. 24-hour monitoring of transient lower esophageal sphincter relaxation events by long-term high-resolution impedance manometry in normal volunteers: the "mirror phenomenon". Neurogastroenterol Motil. 2019 doi: 10.1111/nmo.13530. PubMed DOI

Schneider JH, Küper MA, Königsrainer A, Brücher BL. Transient lower esophageal sphincter relaxation and esophageal motor response. J Surg Res. 2010 doi: 10.1016/j.jss.2009.02.021. PubMed DOI

Westphal M. Science and fiction in critical care: established concepts with or without evidence? Crit Care. 2019 doi: 10.1186/s13054-019-2419-4. PubMed DOI PMC

McClave SA, Lukan JK, Stefater JA, Lowen CC, Looney SW, Matheson PJ, Gleeson K, Spain DA. Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients. Crit Care Med. 2005 doi: 10.1097/01.ccm.0000153413.46627.3a. PubMed DOI

Lewis K, Alqahtani Z, Mcintyre L, Almenawer S, Alshamsi F, Rhodes A, Evans L, Angus DC, Alhazzani W. The efficacy and safety of prokinetic agents in critically ill patients receiving enteral nutrition: a systematic review and meta-analysis of randomized trials. Crit Care. 2016 doi: 10.1186/s13054-016-1441-z. PubMed DOI PMC

Mikami H, Ishimura N, Fukazawa K, Okada M, Izumi D, Shimura S, Okimoto E, Aimi M, Ishihara S, Kinoshita Y. Effects of metoclopramide on esophageal motor activity and esophagogastric junction compliance in healthy volunteers. J Neurogastroenterol Motil. 2016 doi: 10.5056/jnm15130. PubMed DOI PMC