Dysfunction of the lower part of the gastrointestinal tract – current view
Karel Balihar Orcid.org 1, Jana Koželuhová Orcid.org 2, Lucie Fremundová Orcid.org 3, Martin Matějovič Orcid.org 4
+ Affiliation
Summary
Acute gastrointestinal injury (AGI) is one of the key aspects of multiorgan dysfunction syndrome in critically ill patients. The incidence of AGI is associated with increased morbidity and mortality of these patients. AGI occurs in the lower part of the gastrointestinal tract (GIT) and has very diverse manifestations and consequences. We can recognize: 1. reduced absorption of basic nutrients and trace elements, 2. disruption of intestinal motility further complicating nutrient intake and defecation, 3. significant changes in fecal microbiome and barrier function of the gut, with increased intestinal permeability and risk of endotoxemia and 4. last but not least, a very important accelerator of AGI is the presence of intra‑abdominal hypertension. Unlike other organ systems, there is no universal biomarker of AGI. To diagnose AGI in the lower part of the GIT, in common practice we use the information from clinical examination and vital signs. The possibility of intra‑abdominal pressure monitoring can also be of significant benefit. Among the laboratory markers of AGI, testing for the plasma citrulline and proteins of tight junction complex appears to be promising. Unfortunately, most of the other diagnostic methods are usable only in clinical trials because of their difficult implementation in intensive care. In addition to the routine supportive and targeted therapies of the critical illness, in the treatment of AGI we can emphasize: 1. ensuring adequate nutrition and intestinal motility, 2. preventing bacterial overgrowth and maintaining the integrity of fecal microbiome and 3. taking conservative measures or performing surgical decompression to correcting intra‑abdominal hypertension. Early recognition and treatment of AGI lead to a reduced morbidity, and in certain aspects also mortality of critically ill patients.
Keywords
gastrointestinal tract, gastrointestinal motility, intra abdominal hypertension, critical illness, microbiome
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