Abstract
The development of the multiple organ dysfunction syndrome (MODS) is one of the leading causes of death in critically ill patients. Owing to its clinical importance, MODS, as well as acute respiratory distress syndrome and systemic inflammatory response syndrome, has been the focus of significant research to delineate its causes as well as potential therapies for it. A large body of research has focused on the role of the gut in the pathogenesis of MODS, with a special focus on the mechanisms of gut injury as well as the processes by which a localized or limited gut injury is transduced into a systemic inflammatory state. Previous studies have focused on the systemic arm of gut ischemia–reperfusion injury and have largely ignored the non-bacterial intraluminal contents of the gut. The current review will present the hypothesis that the luminal contents of the gut, including the mucus gel layer and intraluminal pancreatic proteases as well as the gut flora, are critically involved in the pathogenesis of ischemia–reperfusion-induced gut injury and the subsequent development of gut-induced MODS.