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Nutrition clinique et métabolisme
Volume 14, n° 4
pages 326-333 (décembre 2000)
Doi : S0985-0562(00)80011-4
accepted : 7 August 2000
L'intestin du patient agressé
Gut dysfunction in the critically ill
 

Jean-Charles Preiser, Jean-Louis Vincent
 Service des soins intensifs, hôpital universitaire Erasme, route de Lennik, 808 B-1070 Bruxelles, Belgique 

*Correspondance et tirés à part.
Résumé

La défaillance multiparenchymateuse ou multiple organ failure complique assez fréquemment l'évolution du patient hospitalisé suite à une agression sévère. Dans différents modèles d'agression expérimentale, chez l'animal, plusieurs éléments de dysfonction intestinale ont été incriminés dans la pathogénie de ce syndrome. L'objectif de cette revue est de récapituler les données cliniques recueillies chez le patient agressé, afin de caractériser les éléments pertinents de dysfonction. Un accroissement de la perméabilité intestinale et une altération de la motricité intestinale ont été clairement démontrés, et des arguments indirects suggèrent la translocation de bactéries, une dysfonction du système immunitaire digestif et une hypoperfusion de la muqueuse intestinale. Les rôles précis de ces anomalies dans la pathogénie de la défaillance multiparenchymateuse restent à élucider.

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Summary

Multiple organ failure syndrome often complicates the course of critically ill patients. In various experimental models, several features of gut dysfunction have been incriminated in the pathogenesis of this syndrome. This work aims at reviewing the clinical data on gut dysfunction recorded in critically ill patients. An increase in gut permeability and an alteration in intestinal motility have been clearly demonstrated, while bacterial translocation, an immune dysfunction and mucosal hypoperfusion are suggested by indirect arguments. The respective roles of these alterations in the pathogenesis of multiple organ failure syndrome remain to be clarified by further investigations.

The full text of this article is available in PDF format.

Keywords : défaillance multiparenchymateuse, flore intestinale, motricité digestive, perfusion splanchnique, perméabilité intestinale, translocation bactérienne

Keywords : bacterial translocation, digestive motility, gut permeability, intestinal flora, multiple organ failure, splanchnic perfusion




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