title: Gut failure in the ICU.
abstract: The role of dysfunction of the gastrointestinal tract in the pathogenesis of multiple organ failure (MOF) complicating the course of critically ill patients has been suspected for more than 40 years. However, several hypotheses have been proposed and sometimes refuted to establish a link. This review summarizes the current knowledge on gastrointestinal physiology and recapitulates existing evidence on the link between gastrointestinal dysfunction and MOF. The gastrointestinal tract has various functions apart from digestion. It produces hormones with local and systemic effects, plays a major role in immunological function, and serves as a barrier against antigens within its lumen. Gastrointestinal dysfunction or gut failure is frequently encountered in critical care patients and is associated with bacterial translocation, which can lead to the development of sepsis, initiation of a cytokine-mediated systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS), and death. The aim of this manuscript is to define gut failure, to review physiopathological mechanisms and clinical implications, and, finally, to suggest preventive measures.
authors: Department of Gastroenterology, Erasme University Hospital, Université libre de Bruxelles, Brussels, Belgium.
authors: Francesco
authors: F
authors: Puleo
authors: Marianna
authors: M
authors: Arvanitakis
authors: André
authors: A
authors: Van Gossum
authors: Jean-Charles
authors: JC
authors: Preiser
mesh_terms: D000818:Animals; D018988:Bacterial Translocation; D016638:Critical Illness; D005767:Gastrointestinal Diseases / Q000150:complications / Q000382:microbiology / Q000503:physiopathology*; D041981:Gastrointestinal Tract / Q000382:microbiology / Q000502:physiology / Q000503:physiopathology; D006801:Humans; D007362:Intensive Care Units; D009102:Multiple Organ Failure / Q000503:physiopathology*; D018805:Sepsis / Q000209:etiology; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology