Ghrelin abates bacterial translocation following burn injury by improving gastric emptying

BACKGROUND: In severe burns, increased intestinal permeability facilitates bacterial translocation, resulting in systemic endotoxemia and multi(-) organ failure. We investigated the role of burn-induced gastrointestinal dysmotility (BIGD) in promoting bacterial translocation following burn injury, and the protective effect of ghrelin in this process. METHODS: We assessed gastric emptying (GE%) and intestinal transit (IT by geometric center "GC") in a 60% total body surface area scald burn rat model and measured bacterial counts in mesenteric lymph nodes (MLN) and distal small intestine by colony-forming unit per gram of tissue (CFU/g). A group of animals was treated with ghrelin or saline after burn. KEY RESULTS: Scald burn was associated with a significant delay in GE (62% +/- 4% vs 74% +/- 4%; P = .02) and a trend of delay in intestinal transit (GC: 5.5 +/- 0.1 vs 5.8 +/- 0.2; P = .09). Concurrently, there was a marginal increase in small intestinal bacterial overgrowth (6 x 10(5) vs 2 x 10(5) CFU/g; P = .05) and significant translocation to MLN (2 x 10(2) vs 4 x 10(1) ; P = .03). We observed a negative correlation between GE and intestinal bacterial overgrowth (rs = -0.61; P = .002) and between IT and translocation (rs = -0.63; P = .004). Ghrelin administration significantly accelerated GE following burn injury (91% +/- 3% vs 62% +/- 4; P = .03), reduced small intestinal bacterial overgrowth, and completely inhibited translocation to MLN (0.0 vs 5 x 10(2) ; P = .01). CONCLUSIONS & INFERENCES: Burn-induced gastrointestinal dysmotility is correlated with the systemic translocation of gram-negative gut bacteria that are implicated in multiple organ failure in burn patients. Therapeutic interventions to restore BIGD are warranted (Neurogastroenterol Motil, 2012, 24, 78).