Gut-origin sepsis: evolution of a concept
Open accessAbstract
The concept of bacterial translocation and gut-origin sepsis as a cause of systemic infectious complications and the multiple organ dysfunction syndrome (MODS) in surgical and ICU patients has emerged over the last several decades, although the exact clinical relevance of these phenomena continues to be debated. Thus, the goal of this review is to trace the evolution of gut-origin sepsis and gut-induced MODS and put these disorders and observations into clinical perspective. Additionally, the mechanisms leading to gut-derived complications are explored as well as therapeutic options to limit or prevent these complications. From this work, several major conclusions emerge. First, that bacterial translocation occurs clinically and is responsible for increased infectious complications in patients undergoing major abdominal surgery. However, the phenomenon of bacterial translocation is not sufficient to explain the development of MODS in ICU patients. Instead, the development of MODS in these high-risk patients is likely due to gut injury and the systemic spread of non-microbial, tissue-injurious factors that reach the systemic circulation via the intestinal lymphatics. These observations have resulted in the gut-lymph hypothesis of MODS.
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Substantial clinical and experimental evidence supports the gut-lymph hypothesis.
“Substantial clinical and experimental evidence supports the gut-lymph hypothesis.”
From The microbiome and critical illness (2016) · cites this paper as [12]
The lungs are the first capillary bed in the body to filter the 1-4 L chyle per day that is emptied into the blood via the thoracic duct.
“the lungs are the first capillary bed in the body to filter the 1–4 L chyle per day that is emptied into the blood via the thoracic duct.”
From The microbiome and critical illness (2016) · cites this paper as [12]
The lower gastrointestinal tract drains into the portal circulation and mesenteric lymph nodes; these nodes drain to the thoracic duct, which empties into the left subclavian vein.
“The lower gastrointestinal tract drains not only into the portal circulation but also into mesenteric lymph nodes. These nodes drain to the thoracic duct, which in turn empties into the left subclavian vein.”
From The microbiome and critical illness (2016) · cites this paper as [12]
In clinical studies of critically ill high-risk surgical patients and in animal studies of shock, bacteria have been cultured from the mesenteric lymph nodes.
“In clinical studies of critically ill high-risk surgical patients and in animal studies of shock, bacteria have been cultured from the mesenteric lymph nodes.”
From The microbiome and critical illness (2016) · cites this paper as [12]
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References 45 · Cited by 359
- Authors
- Deitch, E. A.
- Affiliations
- Rutgers New Jersey Medical School (US)
- Corresponding author
- Deitch, Edwin A.
- Venue
- The Surgeon
- Publisher
- Elsevier BV
- Published
- 2012-12
- Volume
- 10
- Issue
- 6
- Pages
- 350-356
- ISSN
- 1479-666X (ISSN-L)
- PMC
- PMC3413774
- OpenAlex
- W2019766373
- Cited by
- 359
- References
- 45
- Citations by year
- 2026: 20 · 2025: 14 · 2024: 35 · 2023: 19 · 2022: 27 · 2021: 36 · 2020: 35 · 2019: 35 · 2018: 22 · 2017: 26 · 2016: 23 · 2015: 24 · 2014: 24 · 2013: 14 · 2012: 4
- FWCI
- 2.63
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Surgeon (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute of General Medical Sciences (R01GM059841)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Keywords
- bacterial translocation, multiple organ failure, intestinal injury, intestinal lymphatics, postoperative infection, major abdominal surgery, intensive care unit patients, systemic inflammatory response
- MeSH terms
- Bacteria, Humans, Intestines, Bacterial Physiological Phenomena, Sepsis, Bacterial Translocation
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