A scoping review considering potential biomarkers or functional measures of gastrointestinal dysfunction and enteral feeding intolerance in critically ill adults
A scoping review considering potential biomarkers or functional measures of gastrointestinal dysfunction and enteral feeding intolerance in critically ill adults
Background & aim
Enteral feeding intolerance (EFI) as a result of gastrointestinal (GI) dysfunction in critically ill adults can lead to suboptimal nutritional delivery, increasing the risk of hospital acquired malnutrition. There are no validated measures of EFI or consensus as to which measures could be used to define EFI. The aim of this scoping review is to explore the validity of biomarkers, physiological or functional measures of GI dysfunction and EFI in critically ill adults characterising their use in routine clinical practice to identify those with GI dysfunction to better guide nutritional support.
Methods
Database searches were completed in Ovid MEDLINE, Embase, CINAHL and Web of Science using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The search was performed until June 2022. Articles were included if they reported original studies that identify potential biomarkers or functional measures of EFI in critically ill adults. A nine-stage process was completed to extract and complete data synthesis.
Results
139 unique articles were identified. Following review of titles and abstracts, 114 of these articles were excluded, three further articles were excluded after full text review and 22 articles met the inclusion criteria. A thematic analysis of the articles included identified three overarching themes of GI dysfunction: (1) Serum biomarkers, (2) Physiological markers, and (3) Functional markers. Within the category of serum biomarkers, a further three sub-categories were identified: (i) enterohormones, (ii) markers of enterocyte function, and iii) cytokines and neurotransmitters. Some associations were seen between EFI and heparin binding protein, intra-abdominal pressure, cholecystokinin and acetylcholine levels but no markers are currently suitable for daily clinical use.
Conclusions
Further larger studies are required to characterise the relationships between serum biomarkers, physiological and functional makers of GI dysfunction in critically ill adults. A robust definition of GI dysfunction should be included in any future research.
Biomarkers, Critically ill, Enteral feeding, Tolerance
331-339
Jenkins, Bethan
2f7dbc99-8ac2-4121-9448-2b17f2fcaf26
Calder, Philip C.
1797e54f-378e-4dcb-80a4-3e30018f07a6
Marino, Luise V.
002089d0-379b-4c8c-9c95-7976ce709edd
December 2022
Jenkins, Bethan
2f7dbc99-8ac2-4121-9448-2b17f2fcaf26
Calder, Philip C.
1797e54f-378e-4dcb-80a4-3e30018f07a6
Marino, Luise V.
002089d0-379b-4c8c-9c95-7976ce709edd
Jenkins, Bethan, Calder, Philip C. and Marino, Luise V.
(2022)
A scoping review considering potential biomarkers or functional measures of gastrointestinal dysfunction and enteral feeding intolerance in critically ill adults.
Clinical Nutrition ESPEN, 52, .
(doi:10.1016/j.clnesp.2022.09.014).
Abstract
Background & aim
Enteral feeding intolerance (EFI) as a result of gastrointestinal (GI) dysfunction in critically ill adults can lead to suboptimal nutritional delivery, increasing the risk of hospital acquired malnutrition. There are no validated measures of EFI or consensus as to which measures could be used to define EFI. The aim of this scoping review is to explore the validity of biomarkers, physiological or functional measures of GI dysfunction and EFI in critically ill adults characterising their use in routine clinical practice to identify those with GI dysfunction to better guide nutritional support.
Methods
Database searches were completed in Ovid MEDLINE, Embase, CINAHL and Web of Science using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The search was performed until June 2022. Articles were included if they reported original studies that identify potential biomarkers or functional measures of EFI in critically ill adults. A nine-stage process was completed to extract and complete data synthesis.
Results
139 unique articles were identified. Following review of titles and abstracts, 114 of these articles were excluded, three further articles were excluded after full text review and 22 articles met the inclusion criteria. A thematic analysis of the articles included identified three overarching themes of GI dysfunction: (1) Serum biomarkers, (2) Physiological markers, and (3) Functional markers. Within the category of serum biomarkers, a further three sub-categories were identified: (i) enterohormones, (ii) markers of enterocyte function, and iii) cytokines and neurotransmitters. Some associations were seen between EFI and heparin binding protein, intra-abdominal pressure, cholecystokinin and acetylcholine levels but no markers are currently suitable for daily clinical use.
Conclusions
Further larger studies are required to characterise the relationships between serum biomarkers, physiological and functional makers of GI dysfunction in critically ill adults. A robust definition of GI dysfunction should be included in any future research.
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More information
Accepted/In Press date: 14 September 2022
e-pub ahead of print date: 19 September 2022
Published date: December 2022
Additional Information:
Funding Information:
Bethan Jenkins, Pre-Doctoral Clinical Academic Fellow (NIHR301168) is funded by Health Education England (HEE)/National Institute for Health Research (NIHR) for this research project. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS or the UK Department of Health and Social Care.
Funding Information:
LVM is supported by a Southampton Academy of Research Award, University Hospital Southampton NHS Foundation Trust.
Publisher Copyright:
© 2022 European Society for Clinical Nutrition and Metabolism
Keywords:
Biomarkers, Critically ill, Enteral feeding, Tolerance
Identifiers
Local EPrints ID: 470547
URI: http://eprints.soton.ac.uk/id/eprint/470547
ISSN: 2405-4577
PURE UUID: dda86e69-d04c-4d33-9a01-732c713ec1bf
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Date deposited: 12 Oct 2022 16:48
Last modified: 17 Mar 2024 07:31
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Contributors
Author:
Bethan Jenkins
Author:
Luise V. Marino
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