Erythromycin site of action as a motility agent

 Q: Erythromycin is frequently used in ICU as a motility agent. Which part of the stomach it works upon? (select one)

A) cardia

B) fundus

C) body

D) pyloric antrum

E) pyloric canal

Answer: B

Erythromycin is frequently used as a motility agent in ICU as it is a motilin agonist. It works mostly in the stomach as a gastric emptying agent by inducing high-amplitude gastric propulsive contractions. It works mostly at the fundus region which helps in suppressing the fundus' accommodative response after the enteral feed. The lowest starting dose should be used i.e., 40 mg prior to a meal or three times a day to avoid tachyphylaxis which may occur quickly with 250 mg dose three times a day. 

Some institutions follow a proper algorithm for gastroparesis.

#GI

References:

1. Keshavarzian A, Isaac RM. Erythromycin accelerates gastric emptying of indigestible solids and transpyloric migration of the tip of an enteral feeding tube in fasting and fed states. Am J Gastroenterol 1993; 88:193. 

2. Camilleri M. Clinical practice. Diabetic gastroparesis. N Engl J Med 2007; 356:820.