Leading article Gastrointestinal motility problems in critical care: A clinical perspective Abimbola O ADERINTO-ADIKE* & Eamonn M M QUIGLEY* ,† *Department of Medicine, and † Division of Gastroenterology and Hepatology, Weill Cornell Medical College and Houston Methodist Hospital, Houston, Texas, USA Advances in surgery, anesthesia and intensive care have led to a dramatic increase in the number of patients who spend time in our intensive care units (ICU). Gastrointestinal (GI) motility disorders are common complications in the intensive care setting and are predictors of increased mortality and length of the stay in the ICU. Several risk factors for developing GI motility problems in the ICU setting have been identified and include sepsis, being on mechanical ventilation and the use of vasopressors, opioids or anticholinergic medications. Our focus is on the most common clinical manifestations of GI motor dysfunc- tion in the ICU patient: gastroesophageal reflux, gastroparesis, ileus and acute pseudo-obstruction of the colon. KEY WORDS: colonic pseudo-obstruction, critical care, gastroesophageal reflux, gastroparesis, ileus, intensive care unit. INTRODUCTION Gastrointestinal (GI) problems in the critical care setting present a unique challenge in that critically ill patients often cannot voice GI symptoms yet these problems can significantly increase their mortality. 1 GI complications are estimated to occur in approximately 50–80% of patients in the critical care setting. 2 The increased risk of mortality related to GI problems in these patients is associated with increasing risks of infection, prolonged mechanical ventilation and an increasing total hospital stay. 3 In critically ill patients the degree of intestinal dysmotility is directly related to the severity of illness. 4 This review focuses on the more common GI motility problems encountered in the critical care setting: gastroesophageal reflux disease (GERD), gastroparesis, ileus and acute colonic pseudo-obstruction (ACPO). GERD Gastroesophageal reflux is a normal physiological process but becomes pathological when it occurs more frequently or when esophageal exposure to gastric contents leads to symptoms and esophageal mucosal injury. The Montreal Global Consensus defined GERD as a condition that develops when the reflux of con- tents from the stomach causes symptoms and/or complications. 5 The prevalence of GERD varies geo- graphically, with the highest prevalence of 18.1– 27.8% being reported from North America. 6 In a healthy individual, several factors contribute to the prevention of reflux and to minimizing esophageal acid exposure: lower esophageal sphincter (LES) Correspondence to: Eamonn M M QUIGLEY, Division of Gastroenterology and Hepatology, Houston Methodist Hospital, 6550 Fannin St, SM 1001, Houston, TX 77030, USA. Email: equigley@tmhs.org Conflict of interest: None.  2014 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd Journal of Digestive Diseases 2014; 15; 335–344 doi: 10.1111/1751-2980.12147 335