title: The role of the gastrointestinal tract in postinjury multiple organ failure.
abstract: Despite intensive investigation, the pathogenesis of postinjury multiple organ failure (MOF) remains elusive. Laboratory and clinical research strongly implicate that the gastrointestinal tract plays a pivotal role. Shock with resulting gut hypoperfusion appears to be one important inciting event. While early studies persuasively focused attention on bacterial translocation as a unifying mechanism to explain early and late sepsis syndromes that characterize postinjury MOF, subsequent studies suggest that other gut-specific mechanisms are operational. Based on our Trauma Research Center observations and those of others, we conclude that: 1) bacterial translocation may contribute to early refractory shock; 2) for patients who survive shock, the reperfused gut appears to be a source of proinflammatory mediators that may amplify the early systemic inflammatory response syndrome; and 3) early gut hypoperfusion sets the stage for progressive gut dysfunction such that the gut becomes a reservoir for pathogens and toxins that contribute to late MOF.
authors.affiliation: Department of Surgery, University of Texas-Houston Medical School, Hermann Hospital, 77030, USA.
authors.forename: F A
authors.initials: FA
authors.lastname: Moore
mesh_terms: D018988:Bacterial Translocation; D004064:Digestive System / Q000098:blood supply / Q000503:physiopathology*; D006801:Humans; D009102:Multiple Organ Failure / Q000209:etiology / Q000503:physiopathology; D013152:Splanchnic Circulation / Q000502:physiology; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000503:physiopathology