Comparative effects on glucose absorption of intragastric and post-pyloric nutrient delivery in the critically ill

INTRODUCTION: Studies in the critically ill that evaluate intragastric and post-pyloric delivery of nutrient have yielded conflicting data. A limitation of these studies is that the influence in the route of feeding on glucose absorption and glycaemia has not been determined. METHODS: In 68 mechanically ventilated critically ill patients, liquid nutrient (100 ml; 1 kcal/ml containing 3 g of 3-O-Methyl-D-glucopyranose (3-OMG), as a marker of glucose absorption), was infused into either the stomach (n = 24) or small intestine (n = 44) over six minutes. Blood glucose and serum 3-OMG concentrations were measured at regular intervals for 240 minutes and the area under the curves (AUCs) calculated for 'early' (AUC(60)) and 'overall' (AUC(240)) time periods. Data are presented as mean (95% confidence intervals). RESULTS: Glucose absorption was initially more rapid following post-pyloric, when compared with intragastric, feeding (3-OMG AUC(60): intragastric 7.3 (4.3, 10.2) vs. post-pyloric 12.5 (10.1, 14.8) mmol/l.min; P = 0.008); however, 'overall' glucose absorption was similar (AUC(240): 49.1 (34.8, 63.5) vs. 56.6 (48.9, 64.3) mmol/l.min; P = 0.31). Post-pyloric administration of nutrients was also associated with greater increases in blood glucose concentrations in the 'early' period (AUC(60): 472 (425, 519) vs. 534 (501, 569) mmol/l.min; P = 0.03), but 'overall' glycaemia was also similar (AUC(240): 1,875 (1,674, 2,075) vs. 1,898 (1,755, 2,041) mmol/l.min; P = 0.85). CONCLUSIONS: In the critically ill, glucose absorption was similar whether nutrient was administered via a gastric or post-pyloric catheter. These data may have implications for the perceived benefit of post-pyloric feeding on nutritional outcomes and warrant further investigation.