Current knowledge of pathophysiology of ischemia-induced intestinal wall damage: comprehensive analysis of pathogenesis and perspectives

Intestinal ischemia is still one of the most complex pathological processes and characterized by high mortality and difficulties in early diagnosis. The article presents modern data on pathophysiological mechanisms of ischemia-induced intestinal wall damage. Etiological factors, molecular basis of ischemia-reperfusion injury, role of intestinal microbiota and innovative approaches to diagnosis and therapy are considered. Particular attention is paid to the paradoxical role of reperfusion. Indeed, the last one causes almost 70% of structural damages through activation of NADPH oxidase (NOX-4) and mitochondrial dysfunction. Metagenomic studies revealed a critical decrease in microbiota diversity (Shannon index 1.5-2.0) and butyrate deficiency. This directly correlates with violation of intestinal barrier function. In addition, the authors discuss clinical implications of new data, including probiotics and fecal microbiota transplantation. The article highlights the need for interdisciplinary approach involving microbiologists, clinicians and bioinformaticians to develop personalized strategies to reduce mortality and improve treatment outcomes.