Role of the Gut Barrier in Acute Pancreatitis

Capurso, Gabriele; Zerboni, Giulia; Signoretti, Marianna; Valente, Roberto; Stigliano, Serena; Piciucchi, Matteo; Fave, Gianfranco Delle

doi:10.1097/mcg.0b013e3182652096

Cited by 128 publications

(110 citation statements)

References 39 publications

Supporting

Mentioning

104

Contrasting

Unclassified

Order By: Relevance

“…6,17 A failure in the intestinal barrier is a possible cause of sepsis among patients with severe pancreatitis. 17 Mortality increases from less than 3% to greater than 15% among patients with necrotic pancreatitis. Mortality rates rise further if necrotic pancreatic tissue becomes infected.…”

Section: Gallstone Pancreatitis In Pregnancymentioning

confidence: 99%

Gallstone and Severe Hypertriglyceride-Induced Pancreatitis in Pregnancy

Cain

Ellis

Vengrove

et al. 2015

Obstetrical &Amp; Gynecological Survey

View full text Add to dashboard Cite

Patients with acute pancreatitis should be treated with analgesia and fluid resuscitation and maintain a nothing-per-os status. In cases of gallstone pancreatitis, removal of the offending stone through endoscopic retrograde cholangiopancreatography or cholecystectomy can decrease recurrence risk. Severe hypertriglyceride-induced pancreatitis includes similar management. Lipopheresis may be considered in refractory cases. Patients with severe hypercholesterolemia should maintain a low-fat diet and can continue lipid-lowering agents outside the statin class of medications. Preventing severe dyslipidemia in gestation can decrease the risk of pancreatitis and improve maternal and neonatal outcomes.

show abstract

Section: Gallstone Pancreatitis In Pregnancymentioning

confidence: 99%

Gallstone and Severe Hypertriglyceride-Induced Pancreatitis in Pregnancy

Cain

Ellis

Vengrove

et al. 2015

Obstetrical &Amp; Gynecological Survey

View full text Add to dashboard Cite

show abstract

“…Further, patients with BT showed a lower level of occludin and ZO-1 expression [82]. Τhe failure of intestinal barrier is associated with translocation of bacteria and inflammatory products through the intestinal wall, which can be responsible for the infection of the necrotic pancreas and systemic inflammatory response [83]. Higher rates of multiple organ failure and infectious complications were observed in patients with SAP and intestinal dysbiosis: the increase in Enterococcus and decrease in Bifidobacterium [84].…”

Section: Acute Pancreatitismentioning

confidence: 99%

Increased Intestinal Permeability and Decreased Barrier Function: Does It Really Influence the Risk of Inflammation?

2016

View full text Add to dashboard Cite

Background: Increased intestinal permeability due to barrier dysfunction is supposed to cause microbial translocation which may induce low-grade inflammation in various diseases. However, this series of events has not been comprehensively evaluated yet. Summary: Intestinal epithelial barrier dysfunction and increased permeability have been described in patients with inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), alcoholic liver disease, nonalcoholic steatohepatitis (NASH), liver cirrhosis, acute pancreatitis, primary biliary cholangitis (PBC), type 1 and type 2 diabetes, chronic kidney disease, chronic heart failure (CHF), depression, and other diseases. Most clinical reports used either permeability assays of challenge tests or measurement of circulating bacterial markers like endotoxin for assessment of ‘the leaky gut'. The intestinal permeability assessed by the challenge tests has often been related to the changes of tight junction proteins in the epithelium or circulating endotoxin levels. In patients with IBD, alcoholic liver disease, NASH, liver cirrhosis, PBC, obstructive jaundice, severe acute pancreatitis, and CHF, endotoxemia and proinflammatory cytokinemia have been found in addition to increased permeability. In the serum of patients with IBS and depression, antiflagellin antibodies and antilipid A antibodies were detected, respectively, together with increased permeability and proinflammatory cytokinemia. The site of infection, which is localized to the intestine in IBD and IBS, includes various extraintestinal organs in other diseases. The relation of gut dysbiosis to intestinal barrier dysfunction has gradually been clarified. Key Messages: Although no direct cause-and-effect relationship has been confirmed, all clinical and experimental data suggest the importance of intestinal hyperpermeability in the inflammatory changes of various diseases. Increased intestinal permeability is a new target for disease prevention and therapy. Considering the close relationship of ‘the leaky gut' and gut dysbiosis to the major diseases, we can conclude that meticulous dietetic and probiotic approaches to recover healthy microbiota have the potential to make a breakthrough in the management of these diseases tomorrow.

show abstract

“…[14][15][16] In a state of AP, there is increased gut permeability that promotes the development of systemic inflammation and could allow bacterial translocation, which could lead to more severe disease course. [17][18][19][20] Nutrition has an important role in the management of AP by maintaining gut barrier function and inhibiting bacterial translocation. 5,21 Based on the adult literature, we aimed for early oral nutrition when feasible in mild AP through our standardized care efforts.…”

Section: Discussionmentioning

confidence: 99%