Which medications (2) may be beneficial in post-operative patients with high GRVs?

• A. Prokinetic agents (metoclopramide and erythromycin)
• B. Proton pump inhibitors
• C. Laxatives
• D. Anticholinergics

Answer: (A)

Delayed gastric emptying after surgery raises gastric residual volumes, which can increase aspiration risk and hinder feeding. Prokinetic agents help by stimulating gastric motility and speeding emptying, making them the best choice in this scenario.

Metoclopramide works by antagonizing dopamine D2 receptors in the gut and at the chemoreceptor trigger zone, which enhances upper GI motility and increases lower esophageal sphincter tone. This accelerates gastric emptying and can lower GRV. Erythromycin acts as a motilin receptor agonist, promoting strong antral contractions and triggering the migrating motor complex, further improving gastric emptying. Together, these two prokinetics address the core issue of delayed gastric emptying.

In contrast, proton pump inhibitors reduce acid secretion without affecting gastric motility, laxatives act on the colon rather than the stomach, and anticholinergics slow GI transit, potentially worsening GRVs.