THE EFFECT OF GASTROINTESTINAL TRACT ISCHEMIA ON THE DEVELOPMENT OF MULTIPLE ORGAN DYSFUNCTION SYNDROME_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Lianyang , WANG Zhengguo

Research Institute of Surgery, Daping Hospital, The Third Military Medical University,Chongqing 400042;

Corresponding author：

Keywords：

Multiple organ dysfunction syndrome Gastrointestinal tract Ischemia

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Abstract Full text Figures/Tables Video References Cited by

Objective To make clear the effect of gastrointestinal tract ischemia on multiple organ dysfunction syndrome (MODS).
Methods The literature in the recent years was reviewed.
Results The low-flow states of gastrointestinal tract and decrease of gastrointestinal intramucosal pH, which occured following a variety of insults (sever trauma, hemorrhagic shock, et al), as well as overgrowth of enterobacteria, may result in a significant increase of permeability of bowel and lead to endotoxemia and bacterial translocation. Ischemia also resulted in release of TNF, IL-6 into the systemic circulation, dysfunction of gastrointestinal tract motility, and activation of neutrophile which was integral in local and distant organ damage. Conclusion These data suggest that the management of correct ischemia of gastrointestinal tract, which include fluid infusion to replacement of blood volume, early enteral nutrition, improvement of gastrointestinal movement, could contribute to improve the intestinal barrier function, and prevent the development of MODS.

Citation： ZHANG Lianyang,WANG Zhengguo,ZHU Peifang.. THE EFFECT OF GASTROINTESTINAL TRACT ISCHEMIA ON THE DEVELOPMENT OF MULTIPLE ORGAN DYSFUNCTION SYNDROME. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2001, 8(3): 200-201下转封四. doi: Copy

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2.	Vincent JL. Prevention and therapy of multiple organ failure 〔J〕. World J Surg,1996； 20∶465.
3.	Sauaia A, Moore FA, Moore EE, et al. Early risk factors for postinjury multiple organ failure 〔J〕. World J Surg,1996； 20∶392.
4.	Hebra A, Hong J, McGowan KL, et al. Bacterial translocation in mesecteric ischemiareperfusion injury is dysfunctional motility the link〔J〕? Pediatric Surg,1994； 29(2)∶280.
5.	Marshall JC. The gut as a potential trigger of exerciseinduced inflammatory responses 〔J〕. Can J Physiol Pharmacol,1998； 76(5)∶479.
6.	Landow L, Andersen LW. Splanchnic ischemia and its role in multiple organ failure 〔J〕. Acta Anaesthesiol Scand, 1994； 38(7)∶626.
7.	Beuk RJ, Heineman E, Tangelder GJ, et al. Effects of different durations of tatol warm ischemia of the gut on rat messnteric microcirculation 〔J〕. J Surg Res,1997； 73(1)∶14.
8.	Charpentier C, Audibert G, Dousset B, et al.Is endotoxin and cytokine release related to a decrease in gastric intramucosal pH after hemorrhagic shock 〔J〕? Intensive Care Med,1997； 23(10)∶1040.
9.	Morales J, Kibsey P, Thomas PD, et al. The effects of ischemia an ischemiareperfusion on bacterial translocation, lipid peroxidation, and gut histology: studies on hemorrhagic shock in pigs 〔J〕. J Trauma, 1992; 33(2)∶221.
10.	Nieuwenhuijzen GA, Deitch EA, Goris RJ. The relationship between gutdervied bacteria and the development of multiple organ dysfunction syndrome 〔J〕. J Anat,1996； 189(3)∶537.
11.	Nieuwenhuijzen GA, Deitch EA, Goris RJ. Infection, the gut and the development of the multiple organ dysfunction syndrome 〔J〕. Eur J Surg, 1996； 162(4)∶259.
12.	EavesPlyles T, Alexander JW. Rapid and prolonged impairment of gut barrier function after thermal injury in mice 〔J〕. Shock, 1998； 9(2)∶95.
13.	Grotz MR, Deitch EA, Ding J, et al.Intestinal cytokine response after gut ischemia:role of gut barrier failure 〔J〕. Ann Surg,1999； 229(4)∶478.
14.	Yassin MMI, Barros AAB, Parks TG, et al.Lower limb ischaemiareperfusion injury alters gastrointestinal structure and function 〔J〕. Br J Surg,1997； 84∶1425.
15.	Tamion F, Richard V, Lyoumi S, et al. Gut ischemia and mesenteric systhesis of inflammartory cytokines after hemorrhagic or endotoxic shock 〔J〕. Am J Physiol, 1997； 273(Pt 1)∶G314.
16.	Sorkine P, Szold O, Halpem P, et al.Gut decontamination reduces bowel ischemiainduced injury in rats 〔J〕. Chest, 1997； 112(2)∶491.
17.	Mishima S, Xu Dazhong, Lu Qi, et al. Bacterial translocation is inhibited in inducible nitroxide synthase knockout mice after endotoxin challenge but not in a model of bacteri overgrowth 〔J〕. Arch Surg, 1997; 132∶1190.
18.	Hotokezaka M, Mentis EP, Patel SP,et al. Recovery of gastrointestinal tract motility and myoelectric activity change after abdominal surgery 〔J〕. Arch Surg,1997； 132(4)∶410.
19.	Udassin R, Eimerl D, Schiffman J, et al.Postischemic intestinal motility in rat is inversly correlated to length of ischemia:an in vivo animal model.〔J〕 Dig Dis Sci, 1995； 40∶1035.
20.	Tumage RH, Kadesky KM, Rogers T, et al.Neutrophil regulation of splanchin blood flow after hemorrhagic shock. 〔J〕 Ann Surg,1995； 222(1)∶66.
21.	Walley KR, Friessen BP, Humer MF, et al.Small bowel tonometry is more accurate than gastric tonometry in detecting gut ischemia 〔J〕. J Appl Physiol,1998； 85(5)∶1770.
22.	Bengmark S, Gianotti L. Nutritional support to prevent and treat multiple organ failure 〔J〕. World J Surg,1996； 20∶474.
23.	Rowlands BJ, Gardiner KR. Nutritional modulation of gut inflammation 〔J〕. Proc Nutr Soc, 1998； 57(3)∶395.
24.	Wang XD, Soltesz V, Andersson R. Cisapride prevents enteric bacterial overgrowth and translocation by improvement of intestinal motility in rats with acute liver failure 〔J〕. Eur Surg Res,1996； 28∶402.
25.	Spapen HD, Duinsiaeger L, Diltoer M, et al. Gastric emptying in critically ill patients is accelerated by adding cisapride to a standard enteral feeding protocol: results of a prospective, randomized, controlled trial 〔J〕. Crit Care Med,1995； 23(3)∶481.

1. Swank GM, Deitch EA. Role of the gut in multiple organ failure: bacterial translocation and permeability changes 〔J〕. World J Surg,1996； 20(4)∶411.
2. Vincent JL. Prevention and therapy of multiple organ failure 〔J〕. World J Surg,1996； 20∶465.
3. Sauaia A, Moore FA, Moore EE, et al. Early risk factors for postinjury multiple organ failure 〔J〕. World J Surg,1996； 20∶392.
4. Hebra A, Hong J, McGowan KL, et al. Bacterial translocation in mesecteric ischemiareperfusion injury is dysfunctional motility the link〔J〕? Pediatric Surg,1994； 29(2)∶280.
5. Marshall JC. The gut as a potential trigger of exerciseinduced inflammatory responses 〔J〕. Can J Physiol Pharmacol,1998； 76(5)∶479.
6. Landow L, Andersen LW. Splanchnic ischemia and its role in multiple organ failure 〔J〕. Acta Anaesthesiol Scand, 1994； 38(7)∶626.
7. Beuk RJ, Heineman E, Tangelder GJ, et al. Effects of different durations of tatol warm ischemia of the gut on rat messnteric microcirculation 〔J〕. J Surg Res,1997； 73(1)∶14.
8. Charpentier C, Audibert G, Dousset B, et al.Is endotoxin and cytokine release related to a decrease in gastric intramucosal pH after hemorrhagic shock 〔J〕? Intensive Care Med,1997； 23(10)∶1040.
9. Morales J, Kibsey P, Thomas PD, et al. The effects of ischemia an ischemiareperfusion on bacterial translocation, lipid peroxidation, and gut histology: studies on hemorrhagic shock in pigs 〔J〕. J Trauma, 1992; 33(2)∶221.
10. Nieuwenhuijzen GA, Deitch EA, Goris RJ. The relationship between gutdervied bacteria and the development of multiple organ dysfunction syndrome 〔J〕. J Anat,1996； 189(3)∶537.
11. Nieuwenhuijzen GA, Deitch EA, Goris RJ. Infection, the gut and the development of the multiple organ dysfunction syndrome 〔J〕. Eur J Surg, 1996； 162(4)∶259.
12. EavesPlyles T, Alexander JW. Rapid and prolonged impairment of gut barrier function after thermal injury in mice 〔J〕. Shock, 1998； 9(2)∶95.
13. Grotz MR, Deitch EA, Ding J, et al.Intestinal cytokine response after gut ischemia:role of gut barrier failure 〔J〕. Ann Surg,1999； 229(4)∶478.
14. Yassin MMI, Barros AAB, Parks TG, et al.Lower limb ischaemiareperfusion injury alters gastrointestinal structure and function 〔J〕. Br J Surg,1997； 84∶1425.
15. Tamion F, Richard V, Lyoumi S, et al. Gut ischemia and mesenteric systhesis of inflammartory cytokines after hemorrhagic or endotoxic shock 〔J〕. Am J Physiol, 1997； 273(Pt 1)∶G314.
16. Sorkine P, Szold O, Halpem P, et al.Gut decontamination reduces bowel ischemiainduced injury in rats 〔J〕. Chest, 1997； 112(2)∶491.
17. Mishima S, Xu Dazhong, Lu Qi, et al. Bacterial translocation is inhibited in inducible nitroxide synthase knockout mice after endotoxin challenge but not in a model of bacteri overgrowth 〔J〕. Arch Surg, 1997; 132∶1190.
18. Hotokezaka M, Mentis EP, Patel SP,et al. Recovery of gastrointestinal tract motility and myoelectric activity change after abdominal surgery 〔J〕. Arch Surg,1997； 132(4)∶410.
19. Udassin R, Eimerl D, Schiffman J, et al.Postischemic intestinal motility in rat is inversly correlated to length of ischemia:an in vivo animal model.〔J〕 Dig Dis Sci, 1995； 40∶1035.
20. Tumage RH, Kadesky KM, Rogers T, et al.Neutrophil regulation of splanchin blood flow after hemorrhagic shock. 〔J〕 Ann Surg,1995； 222(1)∶66.
21. Walley KR, Friessen BP, Humer MF, et al.Small bowel tonometry is more accurate than gastric tonometry in detecting gut ischemia 〔J〕. J Appl Physiol,1998； 85(5)∶1770.
22. Bengmark S, Gianotti L. Nutritional support to prevent and treat multiple organ failure 〔J〕. World J Surg,1996； 20∶474.
23. Rowlands BJ, Gardiner KR. Nutritional modulation of gut inflammation 〔J〕. Proc Nutr Soc, 1998； 57(3)∶395.
24. Wang XD, Soltesz V, Andersson R. Cisapride prevents enteric bacterial overgrowth and translocation by improvement of intestinal motility in rats with acute liver failure 〔J〕. Eur Surg Res,1996； 28∶402.
25. Spapen HD, Duinsiaeger L, Diltoer M, et al. Gastric emptying in critically ill patients is accelerated by adding cisapride to a standard enteral feeding protocol: results of a prospective, randomized, controlled trial 〔J〕. Crit Care Med,1995； 23(3)∶481.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

THE EFFECT OF GASTROINTESTINAL TRACT ISCHEMIA ON THE DEVELOPMENT OF MULTIPLE ORGAN DYSFUNCTION SYNDROME

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