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(1) Background: Acute muscle inflammation leads to increased sonographic echodensity. We developed a technique to characterize the echodensity of the gastric antrum wall and assess its feasibility in evaluating the severity of acute gastrointestinal injury (AGI); (2) Methods: The B-mode images of the gastric antrum of each enrolled patient were obtained daily by point-of-care ultrasound (POCUS). The 50th percentile, 85th percentile, and mean value of the grayscale distribution according to histogram analysis (ED50, ED85, and EDmean, respectively) were used to characterize the gastric antrum echodensity. Consistency and correlation analyses were performed to evaluate the feasibility and reproducibility of gastric antrum echodensity measurement. The association of gastric antrum echodensity with the severity of AGI and its ability to predict feeding intolerance (FI) were analyzed; (3) Results: In total, 206 POCUS images of 43 patients were analyzed. The gastric antrum echodensity measurements had sufficient intra- and inter-investigator reliabilities (intraclass correlation coefficient >0.9 for all parameters). The ED50 showed a significant upward trend as AGI severity increased, as well as ED85 and EDmean (p for trend 50 (67.8 vs. 56.1, p = 0.02), ED85 (85.6 vs. 71.2, p = 0.01), and EDmean (70.3 vs. 57.6, p = 0.01) upon enteral feeding initiation; (4) Conclusions: Measurement of gastric antrum echodensity was technically feasible and reproducible in ventilated patients. Increased gastric antrum echodensity was associated with greater severity of AGI. Patients with higher gastric antrum echodensity upon enteral nutrition initiation via a nasogastric tube were more likely to develop FI.

BACKGROUND Gastrointestinal (GI) dysfunction is a common and important complication of acute pancreatitis (AP), especially in patients with severe AP. Despite this, there is no consensus means of obtaining a precise assessment of GI function. AIM To determine the association between acute gastrointestinal injury (AGI) grade and clinical outcomes in critically ill patients with AP. METHODS Patients with AP admitted to our pancreatic intensive care unit from May 2017 to May 2019 were enrolled. GI function was assessed according to the AGI grade proposed by the European Society of Intensive Care Medicine in 2012, which is mainly based on GI symptoms, intra-abdominal pressure, and feeding intolerance in the first week of admission to the intensive care unit. Multivariate logistic regression analysis was performed to assess the association between AGI grade and clinical outcomes in critically ill patients with AP. RESULTS Among the 286 patients included, the distribution of patients with various AGI grades was 34.62% with grade I, 22.03% with grade II, 32.52% with grade III, and 10.84% with grade IV. The distribution of mortality was 0% among those with grade I, 6.35% among those with grade II, 30.11% among those with grade III, and 61.29% among those with grade IV, and AGI grade was positively correlated with mortality (χ2 = 31.511, P < 0.0001). Multivariate logistic regression analysis showed that age, serum calcium level, AGI grade, persistent renal failure, and persistent circulatory failure were independently associated with mortality. Compared with the Acute Physiology and Chronic Health Evaluation II score (area under the curve: 0.739 vs 0.854; P < 0.05) and Ranson score (area under the curve: 0.72 vs 0.854; P < 0.01), the AGI grade was more useful for predicting mortality. CONCLUSION AGI grade is useful for identifying the severity of GI dysfunction and can be used as a predictor of mortality in critically ill patients with AP.

Introduction: The incidence of acute gastrointestinal injury (AGI) after colorectal surgery is low when laparoscopic techniques are used. While elevated intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) are associated with AGI grade II, little is known about the relation between increased IAP during laparoscopy and sub- sequent AGI. Aim: To assess the impact of increased IAP during laparoscopic colorectal surgery on the incidence of postoperative AGI. Material and methods: Sixty-six patients (41 men and 25 women) with colorectal cancer undergoing elective lap- aroscopic colorectal surgery were randomized into 3 groups, according to different IAP levels during CO 2 pneumo- peritoneum (10 mm Hg, 12 mm Hg and 15 mm Hg). We recorded the incidence of AGI after surgery by assessing the following parameters: time to first flatus/defecation, time to first bowel movement, time to tolerance of semi-liquid food and the occurrence of vomiting/diarrhea. Moreover, inflammatory mediators were measured before the induc- tion of CO 2 pneumoperitoneum and on postoperative day 1. Results: Acute gastrointestinal injury occurred in 15 (27.3%) patients. In all 3 study groups, the elevation of IAP during CO 2 pneumoperitoneum did not significantly increase the occurrence of symptoms of AGI, vomiting or diar - rhea. Lower IAP levels did not significantly accelerate recovery of gastrointestinal function or shorten postoperative hospital stay. The changes in serum IL-6 after surgery did not correlate with the value of IAP. Conclusions: The level of IAP elevation during laparoscopic colorectal surgery does not increase the occurrence of AGI after surgery.

Gastrointestinal (GI) problems after surgery are common and are not limited to patients undergoing abdominal surgery. GI function is complicated to monitor and is not included in organ dysfunction scores widely used in the ICUs. In most cases, it recovers after surgery, if systemic and local inflammation and perfusion improve, gut oedema resolves, and analgosedation is reduced. However, perioperative GI problems may have severe consequences and increase the risk of death if not recognized and managed in a timely manner. Careful risk evaluation followed by a complex structured assessment and appropriate management of GI symptoms should minimize the potentially severe consequences and thereby possibly improve outcome. In the current review, we summarize common non-specific perioperative GI problems and some specific surgery-related abdominal problems, address identification of patients at risk of GI problems, and give suggestions for perioperative GI management.

Background This prospective study compared clinical characteristics and prognosis between primary (P) and secondary (S) acute gastrointestinal injury (AGI) (P-AGI)/(S-AGI) in critically ill patients. Methods This was a prospective, single-center observational study. Patients were included if they had been hospitalized for at least 72 h before the AGI diagnosis. Patients were classified according to severity of gastrointestinal dysfunction, while P-AGI or S-AGI were defined according to whether the gastrointestinal system was directly or indirectly involved. Clinical characteristics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and Sepsis-related Organ Failure Assessment (SOFA) scores after inclusion and 28-day mortality were recorded. Results Altogether, 282 patients were included: P and S groups enrolled 100 and 182 patients, respectively. The S group patients were older and showed increased morbidities and higher APACHE II and SOFA scores. Compared to the S group, the P group had a higher prevalence in abdominal distention and enteroparalysis and fewer patients at AGI grade I, while more patients at grade III or IV. The S group patients had the higher 28-day mortality. Multiple logistic regression analysis showed AGI grades, APACHE II score, and S-AGI independently predicted the odds of 28-day mortality. Conclusions Comparing to the P-AGI patients, the S group patients were older, with higher APACHE II and SOFA scores. AGI grade, APACHE II score, and S-AGI independently predicted the odds of 28-day mortality in AGI patients.

Background To assess the associations of biomarkers of intestinal barrier function and other clinical variables with acute gastrointestinal injury (AGI) grade, and of these clinical variables with mortality in critically ill patients. Methods This was a single-center, observational, prospective study. Patients were included if they were diagnosed with AGI and underwent tests for the measurement of plasma levels of intestinal fatty acid–binding protein (i-FABP), d-lactate (d-la), and lipopolysaccharide. General characteristics, AGI grades, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, Sepsis-related Organ Failure Assessment (SOFA) scores, intra-abdominal pressure (IAP), and 28-day mortality were recorded and compared among patients with different AGI grades. Results Among the 90 included patients, the APACHE II score, IAP, and LPS and D-la levels significantly differed between the four AGI grades. Multinomial logistic regression analysis with grade I as the reference for grades II, III, and IV revealed that high APACHE II scores increased the odds of AGI grade III (odds ratio [OR], 1.754; 95% confidence interval [CI], 1.225–2.511) and grade IV (OR, 1.493; 95% CI, 1.079–2.066). Similarly, IAP increased the odds of AGI grade III (OR, 1.622; 95% CI, 1.111–2.369) and grade IV (OR, 1.518; 95% CI, 1.066–2.162). Elevated D-la increased the odds of AGI grades II (OR, 1.059; 95% CI, 1.005–1.117), III (OR, 1.155; 95% CI, 1.052–2.268), and IV (OR, 1.088; 95% CI, 1.013–1.168). In contrast, i-FABP and LPS did not increase the odds of any AGI grade. SOFA scores could independently predict the odds of death in AGI patients (OR, 1.223; 95% CI, 1.007–1.485). Conclusion AGI patients exhibit loss of gastrointestinal barrier function, and d-la could serve as a better marker of AGI grade than i-FABP or lipopolysaccharide.

Supplemental Digital Content is available in the text, Background: The aim of the study was to investigate the prevalence and impact of acute gastrointestinal injury (AGI) on clinical outcomes in critically ill patients. Methods: The PubMed, Cochrane, and Embase databases were searched to identify trials that assessed gastrointestinal injury in critically ill patients. Outcome measures were prevalence of AGI among critically ill patients; incidence of mortality among critically ill patients with AGI, and incidence of mortality stratified by severity of AGI. Results: The meta-analysis included 14 studies. The prevalence of AGI in critically ill patients was 40% [95% confidence interval (CI), 27%–54%]; the incidence of mortality among critically ill patients with AGI was 33% (95% CI, 26%–41%). There was a higher risk of mortality in critically ill patients with AGI compared to those without AGI [risk ratio (RR) = 2.01; 95% CI 1.20–3.37, P = .008). Subgroup analyses of studies that defined AGI according to European Society of Intensive Care Medicine (ESICM) criteria confirmed these findings and showed that the risk of mortality was higher in critically ill patients with more severe AGI (ESICM grade III and IV vs grade II) [RR of 1.86 (95% CI 1.48–2.34), P

Background: Sepsis plays an important role in acute gastrointestinal injury (AGI). Our research was designed to determine the effects of omega-3 fish oil (FO) in patients suffering from severe sepsis combined with AGI III, and the ability of FO to modulate immune function. Methods: Seventy-eight patients diagnosed with severe sepsis with AGI III and a need for mechanical ventilation were randomized to two groups. In the FO group, 50 g of long chain fatty acid soybean oil (n = 6) and 10 g of FO (n = 3) were administered as total parenteral nutrition (TPN). The control group was treated with 50 g of long chain fatty acid soybean oil without addition of FO to TPN. Results: At baseline, there were no significant differences between the two groups. The 60-day mortality was lower in the FO group. Multiple factor logistic regression analysis revealed that intra-abdominal pressure (IAP) and abdominal infection were correlated with the FO intervention. The patients with abdominal infection demonstrated a lower mortality rate, fewer CD3 T lymphocytes, and fewer helper/inducer T lymphocytes in the FO group compared with the control group. After 7 days, the Marshall Score was lower in the FO group than in the control group. Conclusion: FO has positive effects in terms of improving the long-term prognosis of patients with severe sepsis with AGI III. Patients with a high IAP and abdominal infection might experience greater benefit from FO. This effect might be due, in part, to immunomodulation. SUMMARY Fish oil (FO) has positive effects in terms of improving the long-term prognosis of patients with severe sepsis with acute gastrointestinal injury Grade IIIPatients with a high intra-abdominal pressure and abdominal infection might experience greater benefit from FOThis effect might be due, in part, to immunomodulation. Abbreviations used: AGI: Acute gastrointestinal injury; FO: Fish oil; TPN: Total parenteral nutrition; IAP: Intra-abdominal pressure; ICU: Intensive Care Unit; MODS: Multiple organ dysfunction syndrome; TLR4: Toll-like receptor 4; DNR: Do Not Resuscitate; WGAP: Working Group of Abdominal Problem; EN: Enteral nutrition; BP: Low blood pressure; CRI: Catheter-related infection; PBS: Phosphate-buffered saline; ELFA: Enzyme-linked fluorescent assay; SD: Standard deviation; PUFAs: Polyunsaturated fatty acids; EPA: Eicosapentenoic acid; DHA: Docosahexaenoic acid.