The role of the gut in sepsis

Sepsis is defined as the systemic inflammatory response syndrome (SIRS) associated with suspected or confirmed infection. As such, it is implicit that two components are necessary in the causation of surgical sepsis: a source of infection as well as a SIRS response by the patient. In recent years, the management of patients with sepsis has been aided by a much better understanding of the underlying pathophysiological processes which occur. In particular, we have a better perception of the complex interactions between the host and the invading organisms as well as a better appreciation of the cellular and extracellular pathways involved, including, but not confined to the complexly intertwined roles of the immunological system, the complement cascade and the coagulation pathway, as well as the role of the gut in driving this process. Given the plethora of homeostatic functions of the gastrointestinal tract, it is self evident, albeit somewhat poorly represented in the medical literature, that this organ plays a central role in the process. This article reviews the role played by the gut in the development of sepsis with a particular emphasis on the surgical patient. The passage of viable bacteria or its components across the gut barrier in a process known as bacterial translocation as well as other mechanisms are also discussed.