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The gut in trauma.

Jayshil J Patel1, Martin D Rosenthal, Keith R Miller

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Trauma significantly impacts gut health, leading to dysfunction and distant organ injury. Emerging therapies show promise for improving gut integrity and function following trauma, but require further clinical trials.

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Area of Science:

  • Gastroenterology
  • Trauma Surgery
  • Immunology

Background:

  • Trauma induces gut dysfunction, contributing to distant organ injury and multiple organ dysfunction syndrome (MODS).
  • The gut microbiome is significantly altered following trauma, potentially shifting towards a pathobiome.
  • Traumatic brain injury (TBI) exacerbates gut dysfunction through the gut-brain axis, increasing intestinal permeability.

Purpose of the Study:

  • To review established and emerging mechanisms of gut injury in trauma.
  • To describe novel strategies for improving gut dysfunction post-trauma.
  • To detail the impact of trauma on the gut microbiome and the gut-brain axis in TBI.

Main Methods:

  • Literature review of established and emerging mechanisms of gut injury in trauma.
  • Analysis of current and novel therapeutic strategies for gut dysfunction.
  • Examination of the role of the gut microbiome and gut-brain axis in trauma.

Main Results:

  • Intraluminal contents, pancreatic enzymes, and hepatobiliary factors disrupt the intestinal mucosa, perpetuating inflammation and MODS.
  • Enteral nutrition and immunonutrition are current therapies; emerging options include protease inhibitors (e.g., tranexamic acid), bombesin, and hypothermia.
  • Trauma-induced gut dysfunction promotes distant organ injury, and TBI activates the gut-brain axis, increasing intestinal permeability.

Conclusions:

  • Gut dysfunction is a critical factor in trauma outcomes, driving systemic inflammation and MODS.
  • Emerging therapies targeting intestinal mucosal integrity show potential but require clinical validation.
  • Understanding the gut microbiome and gut-brain axis is crucial for developing comprehensive trauma care strategies.