The importance of intestinal glutamine metabolism in maintaining a healthy gastrointestinal tract and supporting the body's response to injury and illness.

In critically ill surgical patients, a variety of therapeutic maneuvers are required to maintain a healthy GI tract. Provision of adequate amounts of glutamine to the gastrointestinal mucosa appears to be just one of these maneuvers. Other methods used to protect the GI tract from becoming a wound are (1) to avoid additional systemic and local insults (such as hypotension, sepsis, and multiple operative procedures); (2) to provide aggressive pulmonary care; (3) to use antibiotics judiciously; and (4) to provide aggressive enteral or parenteral feedings. The concept that the intestine is an organ of quiescence after surgical stress merits reconsideration. The intestinal tract plays a central role in interorgan glutamine metabolism and is a key regulator of nitrogen handling after surgical stress. Critically ill patients are susceptible to sepsis of GI origin, the incidence of which is diminished by instituting measures that support intestinal structure, function, and metabolism. Clearly, the biochemical and functional importance of the GI tract in surgical stress demands further elucidation of these factors.