Could oral erythromycin optimize high energy continuous enteral nutrition?

Background: Intravenous erythromycin has previously been reported to stimulate gastric emptying, to inhibit gastric acid secretion and to stimulate pancreatic secretion during continuous gastric infusion of a liquid diet in healthy volunteers. Aim: The aim of this study was to evaluate the effects of oral erythromycin (160 mg/h) on gastrointestinal function under these conditions in seven healthy subjects. Method: This randomized double‐blind cross‐over study measured the gastric emptying rate of nutrients, gastric acid secretion, gastric pH, jejunal flow rate as well as biliopancreatic secretion and duodeno‐caecal transit time during a 19.9 kJ/min continuous infusion of a nutrient solution (4.18 kJ/mL) in the antrum over a 6‐h period by a perfusion method. Results: The nutrition was well tolerated except by one subject with placebo perfusion. During the 6‐h period, total gastric volume and gastric volume of nutrient decreased during erythromycin administration by 22±8 and 22±6%, respectively. Gastric acid secretion was not modified by erythromycin. Lipase and bile salt outputs were significantly higher with erythromycin. The duodeno‐caecal transit time was not statistically different with drug and placebo (169±15 and 146±19 min, respectively). Conclusion: During continuous gastric infusion of a liquid diet, the effect of oral erythromycin on gastric emptying could be useful to optimize cyclic enteral nutrition or to enhance the tolerance of enteral nutrition.