THE INTESTINAL RESPONSE TO CRITICAL ILLNESS

Critical illness is characterized by the presence of several factors t hat can cause marked alterations in the structure and function of mult iple organ systems (1-2). These factors include injury, ischemia, seps is, and starvation (Fig. 1). It is common for more than one of these p roblems to be present in the individual patient. Our current understan ding of the effect of these various factors on intestinal structure an d function has increased markedly during the past decade (3). Furtherm ore, the patterns of intestinal dysfunction that occur in response to these conditions have also been better characterized. Although malabso rption and motility disorders have long been recognized as clinical pr oblems, more recently loss of intestinal barrier function and immune d ysfunction have gained attention. This improved understanding of the r esponse of the intestine to critical illness may lead to prevention of intestinal failure or permit more specific therapy when it occurs. Th e goals of this manuscript are to describe the response of the small i ntestine to critical illness and to identify potential therapeutic str ategies for preventing and treating intestinal failure in this setting .