Early gut mucosal dysfunction in patients with acute pancreatitis.
OBJECTIVE
A clinical study was made to test the hypothesis that gut mucosal damage happens and correlates with endotoxemia, systemic inflammation, severity of disease, septic complication, and outcome in acute pancreatitis (AP) patients.


METHODS
Patients were divided into 3 groups according to severity: grade 1 (n = 26, mild), grade 2 (n = 18, severe AP [SAP] without organ dysfunction), and grade 3 (n = 18, SAP with organ dysfunction). Twenty healthy volunteers were enrolled as control group. The intestinal lactulose and mannitol absorption ratio, d-xylose absorption, endotoxin, and tumor necrosis factor alpha were detected in parallel to clinical data collection.


RESULTS
Lactulose and mannitol absorption ratio increased in patients with AP, and the increase was more pronounced in SAP (grade 1: 0.044 +/- 0.017, grade 2: 0.39 +/- 0.16, grade 3: 0.48 +/- 0.22, control: 0.024 +/- 0.009; P < 0.01 between control and AP, P < 0.01 between mild and severe group). d-Xylose absorption decreased in pancreatitis groups (P < 0.01) especially in severe groups (P < 0.01 between mild and SAP). We also observed a significant positive correlation of mucosal permeability with endotoxin (r = 0.902, P < 0.001) and tumor necrosis factor alpha changes (r = 0.862, P < 0.001). The severity and septic complication in AP patients were different accompanied with severity of gut mucosal damage.


CONCLUSIONS
Intestinal mucosal function is injured in early phase of AP especially in patients with organ dysfunction, which may be a stimulus for development of multiple organ dysfunction and correlate with bad outcome in AP patients.
Liu
Haiyan
H
Medical School of Nanjing University, Research Institute of General Surgery, Jinling Hospital, Nanjing, People's Republic of China.
Li
Weiqin
W
Wang
Xinying
X
Li
Jieshou
J
Yu
Wenkui
W
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D004731:Endotoxins / Q000097:blood; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007408:Intestinal Absorption; D007410:Intestinal Diseases / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology; D007413:Intestinal Mucosa / Q000378:metabolism / Q000503:physiopathology*; D007792:Lactulose / Q000652:urine; D007902:Length of Stay; D008297:Male; D008353:Mannitol / Q000652:urine; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000503:physiopathology; D010195:Pancreatitis / Q000150:complications* / Q000378:metabolism / Q000503:physiopathology; D010539:Permeability; D011379:Prognosis; D011446:Prospective Studies; D018805:Sepsis / Q000209:etiology / Q000503:physiopathology; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D014994:Xylose / Q000652:urine
D004731:Endotoxins; D014409:Tumor Necrosis Factor-alpha; D008353:Mannitol; D007792:Lactulose; D014994:Xylose