To synthesize current evidence on the role of the gastrointestinal system, particularly the stomach, in post-traumatic sepsis and propose a novel 'Gastrointestinal Axis' (GIA) framework.
Approach:
Literature Review: A comprehensive literature search of PubMed, Web of Science, and Scopus was conducted to identify relevant peer-reviewed studies on gut barrier dysfunction, dysbiosis, autophagy, and immune responses in post-traumatic sepsis.
Key Findings:
Post-traumatic sepsis is a leading cause of late mortality in ICUs, with increasing incidence and mortality rates.
The gastrointestinal tract, particularly the stomach, plays an active role in the pathogenesis of post-traumatic sepsis.
Gastric autophagy is proposed as a regulatory node in the GIA, influencing intestinal barrier integrity and systemic inflammation.
Emerging biomarkers such as intestinal fatty acid-binding protein, D-lactate, citrulline, and the Acute Gastrointestinal Injury grading system enable multimodal risk stratification.
Early enteral nutrition and synbiotics show promise in mitigating post-traumatic sepsis.
Interpretation:
The GIA framework integrates gastric and intestinal dysfunction as interconnected drivers of post-traumatic sepsis.
Limitations:
Direct evidence for gastric mucosal autophagy in human post-traumatic sepsis is limited.
The causal relationship between gastric autophagy failure and downstream intestinal injury remains a hypothesis requiring further validation.
Conclusion:
The GIA concept reframes gastric and intestinal protection as an integrated therapeutic strategy for preventing post-traumatic sepsis.
