I can't therefore say whether "Guts" is representational of his larger body of work, but the content didn't come as a shock to me. I've long heard that he likes to dive into the muck and the mire and with a masculine sense of humour. Plus, this story first appeared on the pages of Playboy, so I wasn't expecting Pride and Prejudice. That said, it's still an odd choice for Playboy. By the end of the story, I can't imagine feeling any unsexier. I don't think the original intent of that publication was to leave their regular readers squeamish or even repulsed.
But I still enjoyed it. He goes for the gross-out, for sure, but the build-up is great. It has a dark comedy feel at first but develops an urban legend vibe as the story progresses. Apparently Palahniuk likes to claim that the number of listeners who've fainted as he reads it aloud continues to grow. I'm not sure if I believe that, but it certainly adds to its fun urban legend appeal.