Gastric colonisation, intestinal permeability and septic morbidity in acute pancreatitis

McNaught, Clare; Woodcock, N P; Mitchell, C. J.; Rowley, George R.; Johnstone, D; MacFie, John

doi:10.1159/000064712

Cited by 40 publications

(33 citation statements)

References 32 publications

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“…In the 1990s, several authors observed a positive correlation between bacterial translocation and IAP in animal models, even when IAP was raised for less than 1 h. This result was caused by increased gut permeability induced by splanchnic ischemia with and without reperfusion [27,28] . The mechanism by which the necrotic pancreas becomes infected is unclear, but experimental and clinical data suggest that the gastrointestinal tract is the likely source of organisms, since intestinal colonization by pathogens often precedes pancreatic infection [29][30][31][32][33] . The gut clearly plays a major role in the development of MODS.…”

Section: Discussionmentioning

confidence: 99%

Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage

Chen¹,

Li²,

Sun³

et al. 2008

WJG

123

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AIM:To study retrospectively the influence of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in patients with early acute pancreatitis (AP) (during the first week after admission) on physiological functions, and the association of the presence of IAH/ACS and outcome. METHODS: Patients (n = 74) with AP recruited in this study were divided into two groups according to intra-abdominal pressure (IAP) determined by indirect measurement using the transvesical route via Foley bladder catheter during the first week after admission. Patients (n = 44) with IAP ≥ 12 mmHg were assigned in IAH group, and the remaining patients (n = 30) with IAP < 12 mmHg in normal IAP group. For analysis of the influence of IAH/ACS on organ function and outcome, the physiological parameters and the occurrence of organ dysfunction during intensive care unit (ICU) stay were recorded, as were the incidences of pancreatic infection and in-hospital mortality. RESULTS: IAH within the first week after admission was found in 44 patients (59.46%). Although the APACHE Ⅱ scores on admission and the Ranson scores within 48 h after hospitalization were elevated in IAH patients in early stage, they did not show the statistically significant differences from patients with normal IAP within a week after admission (16.18 ± 3.90 vs 15.70 ± 4.25, P = 0.616; 3.70 ± 0.93 vs 3.47 ± 0.94, P = 0.285, respectively). ACS in early AP was recorded in 20 patients (27.03%). During any 24-h period of the first week after admission, the recorded mean IAP correlated significantly with the Marshall score calculated at the same time interval in IAH group (r = 0.635, P < 0.001). Although ACS patients had obvious amelioration in physiological variables within 24 h after decompression, the incidences of pancreatitic infection, septic shock, multiple organ dysfunction syndrome (MODS) and death in the patients with ACS were significantly higher than that in other patients without ACS (pancreatitic infection: 60.0% vs 7.4%, P < 0.001; septic shock: 70.0% vs 11.1%, P < 0.001; MODS: 90.0% vs 31.5%, P < 0.001; mortality: 75.0% vs 3.7%, P < 0.001). CONCLUSION: IAH/ACS is

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Section: Discussionmentioning

confidence: 99%

Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage

Chen¹,

Li²,

Sun³

et al. 2008

WJG

123

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“…First, there is compelling evidence that in severe acute pancreatitis gut barrier function is compromised resulting in greater intestinal permeability to bacteria (which may lead to infected necrosis) and endotoxins (which stimulate nitric oxide and cytokine production that contribute to organ failure) (98-100, 179). There is also evidence that there is a higher incidence of gastric colonization with potentially pathogenic enteric bacteria in severe disease that may also contribute to septic complications (130). Because enteral feeding stabilizes gut barrier function, there has been considerable interest in the ability of enteral feeding not only to provide appropriate nutritional support, but also to prevent systemic complications and improve morbidity and mortality.…”

Section: Level Of Evidence: IImentioning

confidence: 99%

Practice Guidelines in Acute Pancreatitis

Banks

Freeman

2006

Am J Gastroenterology

1,677

980

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“…Microbial contamination of the injured pancreatic tissues is thought to be a consequence of the translocation of viable organisms across the mucosa of the gastrointestinal tract (63). The development of infection may be suggested by fever, leukocytosis, or evidence of persistent or evolving organ dysfunction; however, these manifestations are nonspecific.…”

Section: Grade Cmentioning

confidence: 99%

Source control in the management of severe sepsis and septic shock: An evidence-based review

Marshall

Maier

Jimenez

et al. 2004

Critical Care Medicine

238

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Source control represents a key component of success in therapy of sepsis. It includes drainage of infected fluids, debridement of infected soft tissues, removal of infected devices or foreign bodies, and finally, definite measures to correct anatomic derangement resulting in ongoing microbial contamination and to restore optimal function. Although highly logical, since source control is the best way to reduce quickly the bacterial inoculum, most recommendations are, however, graded as D or E due to the difficulty to perform appropriate randomized clinical trials in this respect. Appropriate source control should be part of the systematic checklist we have to keep in mind in setting up the therapeutic strategy in sepsis.

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Gastric colonisation, intestinal permeability and septic morbidity in acute pancreatitis

Cited by 40 publications

References 32 publications

Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage

Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage

Practice Guidelines in Acute Pancreatitis

Source control in the management of severe sepsis and septic shock: An evidence-based review

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