Edgar J. Poth lecture. The surgeon and gut maintenance.

The gastrointestinal tract is metabolically active, requires specific nutrients, and is important both for substrate redistribution and barrier function. The provision of optimal support can be expected to obviate the stress-related response associated with increased gut permeability and bacterial translocation. Enteral feeding is the preferable technique whenever it is possible. It should be used to provide whatever level of nutrients the gut will accommodate, even when it may not immediately support full feeding. Parenteral administration of gut-specific nutrients may be an option in the near future. Judicious consideration of the effects of antibiotics and other drugs on indigenous flora is also important.