The Effect of Intestinal Permeability and Endotoxemia on the Prognosis of Acute Pancreatitis

Koh, Young Yool; Jeon, Woo Kyu; Cho, Yong Kyun; Kim, Hong Joo; Chung, Won Gil; Chon, Chang Uk; Oh, Tae Yun; Shin, Jun Ho

doi:10.5009/gnl.2012.6.4.505

Cited by 43 publications

(34 citation statements)

References 22 publications

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“…Patients classified as SAP were found to have higher intestinal permeability, serum endotoxin level, and cytokine level [37]. More remote organ involvement or even OF caused by SIRS might occur.…”

Section: Discussionmentioning

confidence: 95%

Enteral Nutrition within 48 Hours of Admission Improves Clinical Outcomes of Acute Pancreatitis by Reducing Complications: A Meta-Analysis

Chen

et al. 2013

PLoS ONE

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BackgroundEnteral nutrition is increasingly advocated in the treatment of acute pancreatitis, but its timing is still controversial. The aim of this meta-analysis was to find out the feasibility of early enteral nutrition within 48 hours of admission and its possible advantages.Methods and FindingsWe searched PubMed, EMBASE Databases, Web of Science, the Cochrane library, and scholar.google.com for all the relevant articles about the effect of enteral nutrition initiated within 48 hours of admission on the clinical outcomes of acute pancreatitis from inception to December 2012. Eleven studies containing 775 patients with acute pancreatitis were analyzed. Results from a pooled analysis of all the studies demonstrated that early enteral nutrition was associated with significant reductions in all the infections as a whole (OR 0.38; 95%CI 0.21–0.68, P<0.05), in catheter-related septic complications (OR 0.26; 95%CI 0.11–0.58, P<0.05), in pancreatic infection (OR 0.49; 95%CI 0.31–0.78, P<0.05), in hyperglycemia (OR 0.24; 95%CI 0.11–0.52, P<0.05), in the length of hospitalization (mean difference −2.18; 95%CI −3.48−(−0.87); P<0.05), and in mortality (OR 0.31; 95%CI 0.14–0.71, P<0.05), but no difference was found in pulmonary complications (P>0.05). The stratified analysis based on the severity of disease revealed that, even in predicted severe or severe acute pancreatitis patients, early enteral nutrition still showed a protective power against all the infection complications as a whole, catheter-related septic complications, pancreatic infection complications, and organ failure that was only reported in the severe attack of the disease (all P<0.05).ConclusionEnteral nutrition within 48 hours of admission is feasible and improves the clinical outcomes in acute pancreatitis as well as in predicted severe or severe acute pancreatitis by reducing complications.

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Section: Discussionmentioning

confidence: 95%

Enteral Nutrition within 48 Hours of Admission Improves Clinical Outcomes of Acute Pancreatitis by Reducing Complications: A Meta-Analysis

Chen

et al. 2013

PLoS ONE

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“…Increased intestinal permeability was confirmed by several methods in patients with acute pancreatitis [77,78,79,80]. The intestinal permeability was correlated with plasma endotoxin [77,79,80], serum TNF-α [77,80], IL-6, CRP, and the severity index estimated by computed tomography [80].…”

Section: Acute Pancreatitismentioning

confidence: 99%

“…The intestinal permeability was correlated with plasma endotoxin [77,79,80], serum TNF-α [77,80], IL-6, CRP, and the severity index estimated by computed tomography [80]. The urinary concentration of intestinal fatty acid-binding protein, a sensitive marker of intestinal ischemia, correlated positively with intestinal permeability, which suggests that splanchnic hypoperfusion induces the loss of intestinal mucosal integrity [78].…”

Section: Acute Pancreatitismentioning

confidence: 99%

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

2016

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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.

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“…). 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 ).…”

Section: Resultsmentioning

confidence: 99%

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

Sankaran

Plank

et al. 2014

British Journal of Surgery

126

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The Effect of Intestinal Permeability and Endotoxemia on the Prognosis of Acute Pancreatitis

Cited by 43 publications

References 22 publications

Enteral Nutrition within 48 Hours of Admission Improves Clinical Outcomes of Acute Pancreatitis by Reducing Complications: A Meta-Analysis

Enteral Nutrition within 48 Hours of Admission Improves Clinical Outcomes of Acute Pancreatitis by Reducing Complications: A Meta-Analysis

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

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

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