[Acute failure of the intestinal barrier--pathophysiology, diagnosis, prophylaxis and therapy]

The gut not only serves as a main target for the detrimental effects of stress during and after surgery, but may also promote the development of multiple organ failure after different types of severe shock. According to a current hypothesis, an impaired intestinal barrier function is associated with a decreased separation of intraluminal bacteria and toxins and systemic circulation, which may induce sepsis and multiple organ failure. Hypoperfusion during shock, reperfusion injury of the splanchnic mucosa, alterations of the micro-ecology of the gut and immunologic and hormonal disturbances are important underlying pathophysiological mechanisms. Various therapeutic concepts have been proposed such as improvement of splanchnic perfusion, nutritive and metabolic treatment by means of immunomodulating nutrients, parenteral substitution of glutamine, early onset of enteral nutrition, normalization of gut motility and selective decontamination of the gut. However, no clinical study to date could clearly demonstrate a key role of the gut in the pathogenesis of sepsis and multiple organ failure. Likewise, the efficacy of different prophylactic and therapeutic procedures remain to be studied. An aggressive treatment of shock and avoidance of microcirculatory disturbances are of principal importance for prophylaxis of multiple organ failure.