Key words: intestinal ischemia-reperfusion, biomarkers, diagnostic work-up, therapeutic strategy, intestinal barrier function, digestive enzymes

"New insights in intestinal ischemia-reperfusion; Towards a better diagnostic work-up and therapeutic strategy"

Intestinal oxygen deficiency, or intestinal ischemia, is a common, serious condition associated with a high mortality rate. The high mortality rate is partly determined by the lack of good diagnostic tests, as a result of which intestinal ischemia is often detected at a late stage. This dissertation shows that the new blood tests I-FABP and SM22 are valuable additions in the early diagnostics of patients with intestinal ischemia. In the future, both blood tests may enable us to determine the severity of the intestinal ischemia in daily patient care and thus to choose a better treatment strategy. In addition, the high mortality rate is the result of insufficient knowledge about what exactly happens during times of intestinal ischemia. A better understanding of the processes that occur during intestinal ischemia is needed. This research discovered that the small intestine can tolerate short periods of intestinal ischemia well and recover fully functional. As a result, the small intestine is able to prevent inflammation that spreads to the entire body. Finally, this thesis shows for the first time in humans that during intestinal ischemia digestive enzymes leak out of the intestine and damage body tissues, leading to a severe inflammatory response. This lead will possibly result in the first preventive and therapeutic strategies to combat intestinal ischemia in humans in the future. 

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