Infection, the gut and the development of the multiple organ dysfunction syndrome.

It has been hypothesised that failure of the gut is an important pathophysiological phenomenon of the generalised inflammatory response that leads to the multiple organ dysfunction syndrome (MODS). Abnormal colonisation, infections of gut origin, bacterial translocation are all signs of gut failure that have been implicated in the pathogenesis of MODS. We have concluded after summarising published experimental and clinical studies that have tried to correlate the occurrence or prevention (by selective decontamination of the digestive tract) of these phenomena with the development of MODS, it seems that in some patients it is clear that loss of intestinal barrier function or the onset of infection precedes the development of MODS. In other patients, however, this relationship is not so clear and it seems that these phenomena may reflect a failure of the host's immune and mechanical defence systems and are epiphenoma of critical illness. The causal relation between those phenomena and the development of MODS are complex and need further clarification.