Although they occur less frequently than cardiopulmonary events, gastrointestinal complications now are recognized increasingly in chronically critically ill patients. These are usually the consequence of systemic processes and multiorgan dysfunction that are prevalent in this patient population. Recognition of gastrointestinal complications in critically ill patients is extremely challenging because classic signs and symptoms are often absent or masked by the frequent use of sedative and narcotic medications in intubated patients. Moreover, laboratory and radiologic studies are not always helpful. This situation often results in delayed diagnosis which, in turn, leads to increased mortality. In this article, the authors review the epidemiology, clinical features, diagnosis, prevention, and management of the various gastrointestinal complications that occur in a chronically ventilated patient. These critically ill patients receive their care both in long-term acute care facilities and in intensive care units (ICUs).