AIM:To sum up the recent 30-year experience in the prevention and treatment of gastrointestinal dysfunction in severe burn patients,and propose practicable guidelines for the prevention and treatment of gastrointestinal (GI) dysfunction.METHODS= From 1980 to 2007,a total of 219 patients with large area and extraordinarily large area burns (LAB) were admitted,who were classified into three stages according the therapeutic protocols used at the time:Stage 1 from 1980 to 1989,stage 2 from 1990 to 1995,and stage 3 from 1996 to 2007.The occurrence and mortality of GI dysfunction in patients of the three stages were calculated and the main causes were analyzed.RESULTS:The occurrence of stress ulcer in patients with LAB was 8.6% in stage 1,which was significantly lower than that in stage 1 (P ＜ 0.05).No massive hemorrhage from severe stress ulcer and enterogenic infections occurred in stages 2 and 3.The occurrence of abdominal distension and stress ulcer and the mortality in stage 3 patients with extraordinarily LAB was 7.1%,21.4% and 28.5%,respectively,which were significantly lower than those in stage 1 patients (P ＜ 0.05 or P ＜ 0.01),and the occurrence of stress ulcer was also significantly lower than that in stage 2 patients (P ＜ 0.05).CONCLUSION:Comprehensive fluid resuscitation,early excision of necrotic tissue,staged food ingestion,and administration of specific nutrients are essential strategies for preventing gastrointestinal complications and lowering mortality in severely burned patients.