Alterations in intestinal permeability and endotoxemia in severe acute pancreatitis

Abstract

Background: Intestinal permeability increases early in the course of acute pancreatitis and is associated with sepsis and organ failure.Aim: To evaluate the intestinal permeability (IP) and anti-endotoxin antibodies immunoglobulin G and A (AEA IgG and A) in severe acute pancreatitis (SAP) as compared to healthy controls and determine their significance in relation to various complications of SAP. Methods: IP was measured by urinary lactulose/mannitol (LM) excretion ratio and antiendotoxin antibodies by Endocab ELISA kit at days one and seven of admission (D1 and D7). Results: Thirty one patients of SAP [mean age (42.0±15.8) years, APACHE II scores (8.8±5.4) and CT severity index (6.4±2.0)] were included in this study. Infected pancreatic necrosis was detected in 13 (42%) patients of whom three died. Six died of persistent organ failure. Median values of LM ratio at D1 and D7 were similar to those in healthy controls. Patients experiencing complications [organ failure (4/9, 44%), infected pancreatic necrosis (5/10, 50%) and death (1/ 2, 50%)] manifested a substantial increase in their intestinal permeability at D7. Anti-endotoxin antibodies IgG were lower (p=0.003) in patients than the controls at admission. AEA IgG were lower (p=0.03) in non-survivors as compared to survivors at D7. Conclusion: Patients experiencing complications of severe acute pancreatitis showed an increase in intestinal permeability. Higher endotoxemia predicted poor outcome in severe acute pancreatitis.

Carbon monoxide–based therapy ameliorates acute pancreatitis via TLR4 inhibition

“…Levels of endotoxins such as LPS and TLR4 ligand correlate with systemic complications, mortality, and disease severity in patients with AP (28). Patients with severe and complicated AP have elevated endotoxin levels in blood and peritoneal fluid (29). However, the initial injury and early complications associated with AP are likely related to sterile inflammatory process or endogenous ligand-mediated TLR activation, not to endotoxins (30).…”

Meta-analysis of gut barrier dysfunction in patients with acute pancreatitis

“…). Forty‐six articles were excluded at this stage, yielding a total of 44 studies that were included in the systematic review. There were 13 randomized clinical trials and 31 observational studies, which included both prospective cohort and case–control studies ( Table ).…”

Dynamic Changes of the Colonic Microbiota in Rat during Severe Acute Pancreatitis

“…The cause of splanchnic hypoperfusion is mainly due to hypovolemia (13). It is possible that severe volume depletion accompanying AP might cause a partial ischemic injury to the intestinal mucosa.…”