Post-injury multiple organ failure: The role of the gut

Despite intensive investigation, the pathogenesis of post-injury multiple o rgan failure (MOF) remains elusive. Laboratory and clinical research strong ly suggests that the gastrointestinal tract (i.e., the gut) plays a pivotal pathogenic role. Since its inception in 1988, the Trauma Research Center ( TRC) at the University of Texas-Houston Medical School (UTHMS) has focused its efforts on elucidating the role of the gut in post-injury MOF. On the b asis of our observations and those of others, we believe that 1) shock with resulting gut hypoperfusion is an important inciting event, 2) the reperfu sed gut is a source of proinflammatory mediators that can amplify the early systemic inflammatory response syndrome (SIRS) and thus contribute to earl y MOF, 3) early gut hypoperfusion causes an ileus in both the stomach and s mall bower that sets the stage for progressive gut dysfunction so that the proximal gut becomes a reservoir for pathogens and toxins that contribute t o late sepsis-associated MOF, and 4) late infections cause further worsenin g of this gut dysfunction. Thus, the gut can be both an instigator and a vi ctim of MOF. The purpose of this article is to provide the rationale behind these beliefs and to provide a brief overview of the ongoing research proj ects in the TRC at UTHMS.