The role of the gastrointestinal tract in postinjury multiple organ failure

Am J Surg. 1999 Dec;178(6):449-53. doi: 10.1016/s0002-9610(99)00231-7.


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.

Publication types

  • Lecture
  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Bacterial Translocation
  • Digestive System / blood supply
  • Digestive System / physiopathology*
  • Humans
  • Multiple Organ Failure* / etiology
  • Multiple Organ Failure* / physiopathology
  • Splanchnic Circulation / physiology
  • Systemic Inflammatory Response Syndrome / etiology
  • Systemic Inflammatory Response Syndrome / physiopathology