The gut: A central organ after surgical stress

D. W. Wilmore, R. J. Smith, S. T. O'Dwyer, D. O. Jacobs, T. R. Ziegler, X. D. Wang

Research output: Contribution to journalReview article

541 Scopus citations

Abstract

The derangements in the intestinal mucosa associated with starvation, injury, infection, immunosuppression, chemotherapy, lack of enteral feedings, and other stresses are associated with a breakdown in the barrier function of the gut. Both bacteria and their toxins may enter the host from the intestinal lumen. Through interaction with the reticuloendothelial system, cytokines are produced, which stimulate the pituitary-adrenal axis thus contribute to the stress response. The elaboration of glucocorticoids facilitates proteolysis, thus increasing glutamine release from skeletal muscle for gut repair. Although this homeostatic mechanism appears to aid mucosal repair and support immunologic response, severe injury or prolonged glutamine deficits do not adequately support intestinal recovery and allow this cycle to become self-perpetuating. Adequate enteral feedings initiated early in the course of a disease appear to maintain adequate gut barrier function. In the frequent circumstance when feeding by this route is inadequate or impossible, glutamine-containing parenteral feedings offer an appropriate alternative therapy for bowel and immunologic support. Glutamine-containing parenteral feedings are associated with increased mucosal cellularity and improved survival after gut injury. Specific hormones also stimulate mucosal growth, and it is anticipated that a combination of hormones and specific nutrients will provide optimal support of the gut mucosa in the severely ill patient.

Original languageEnglish (US)
Pages (from-to)917-923
Number of pages7
JournalSurgery
Volume104
Issue number5
StatePublished - Jan 1 1988

ASJC Scopus subject areas

  • Surgery

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    Wilmore, D. W., Smith, R. J., O'Dwyer, S. T., Jacobs, D. O., Ziegler, T. R., & Wang, X. D. (1988). The gut: A central organ after surgical stress. Surgery, 104(5), 917-923.