GUT INJURY AFTER MAJOR ABDOMINAL-SURGERY - THE ROLE OF NEUTROPHIL ACTIVATION AND ENTERAL NUTRITION

Objective: To review recent data on the consequences of the loss of gu t integrity after major abdominal surgery, with emphasis on the role o f polymorphonuclear leukocytes (PMN), The role of enteral nutrition as a therapeutic strategy will be discussed, Data and Sources: Recent li terature on the role of PMN in intestinal damage and the value of earl y enteral nutrition in the maintenance of intestinal blood flow and ba rrier function was evaluated. Results and Conclusions: PMN play an imp ortant role in the loss of gut integrity following abdominal surgery. After intestinal ischemia-reperfusion, activated PMN accumulate in the mucose where they can mediate tissue damage via secretion of proteoly tic enzymes and oxygen radicals, This type of gut injury might be prev ented by maintaining adequate blood flow to the gut. Early enteral fee ding and the addition of glutamine during periods of stress might be i mportant in preserving blood flow to the splanchnic bed. Furthermore, potential routes for the inhibition of PMN-mediated mucosal damage sho uld be further investigated.