High-dose Catecholamines Diminish the Effect of Erythromycin on Antral Motility and Gastric Emptying in Intensive Care Unit Patients

Gastric emptying is impaired in about half of all critically ill patients [1]. This may delay the start of enteral feeding and lead to large gastric residues. In addition, this situation may favor the occurrence of duodenogastric reflux, thereby predisposing the patient to colonization of the stomach by enteric bacteria. Several motility- enhancing drugs, such as metoclopramide or cisapride, are used in this setting, although their clinical effects are limited. Erythromycin is a macrolide antibiotic, which as a ’side effect’ strongly stimulates gastroduodenal motility via stimulation of receptors for motilin, a gastrointestinal hormone [2, 3]. It has also been shown that erythromycin is effective in intensive care unit (ICU) patients [4]. Although erythromycin is increasingly used for improving gastric emptying in ICU patients, little is known about its interaction with other drugs often used in this setting, such as catecholamines or opiates, which delay gastric emptying. The aim of this study was to test for any influence of catecholamines on the effect of erythromycin concerning antral motility and gastric emptying.