Anti-inflammatory effects of peritoneal lavage in acute pancreatitis.
OBJECTIVE
Intraperitoneal administration of trypsin stimulates the production of cytokines from peritoneal macrophages. Removing the pancreatitis-associated ascitic fluid from the peritoneal cavity may decrease the systemic inflammatory response in acute pancreatitis (AP). We investigated the effect of peritoneal lavage on the systemic inflammatory response in severe AP.


METHODS
Acute pancreatitis was induced in Wistar rats by 5% taurocholate intraductal injection. Peritoneal lavage was performed for 4 hours after onset of AP. At 4 hours after induction of AP, serum samples were assayed for amylase and inflammatory cytokines (tumor necrosis factor α, interleukin-6 [IL-6], and IL-10). Expression of pancreatic cyclooxygenase-2 and inducible nitric oxide synthase, liver mitochondrial function, and pulmonary myeloperoxidase activities were determined.


RESULTS
Peritoneal lavage after AP led to a decrease in serum levels of tumor necrosis factor α and IL-6 and an increase in IL-10. In the pancreas, this treatment reduced cyclooxygenase-2 and inducible nitric oxide synthase expression. Liver mitochondrial dysfunction was also reduced. There were no differences on serum amylase levels and pulmonary myeloperoxidase between groups with AP.


CONCLUSIONS
Peritoneal lavage has a systemic anti-inflammatory effect in severe AP and may be able to decrease the severity of severe AP.
Souza
Lourenilson José
LJ
Department of Gastroenterology, University of São Paulo, São Paulo, Brazil.
Coelho
Ana Maria Mendonça
AM
Sampietre
Sandra N
SN
Martins
Joilson O
JO
Cunha
José Eduardo M
JE
Machado
Marcel Cerqueira Cesar
MC
D000208:Acute Disease; D000244:Adenosine Diphosphate / Q000378:metabolism; D000681:Amylases / Q000097:blood; D000818:Animals; D051546:Cyclooxygenase 2 / Q000378:metabolism; D015151:Immunoblotting; D007249:Inflammation / Q000097:blood / Q000628:therapy*; D018836:Inflammation Mediators / Q000097:blood; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008168:Lung / Q000201:enzymology; D008297:Male; D008930:Mitochondria, Liver / Q000378:metabolism; D052247:Nitric Oxide Synthase Type II / Q000378:metabolism; D010100:Oxygen / Q000378:metabolism; D010179:Pancreas / Q000201:enzymology / Q000473:pathology; D010195:Pancreatitis / Q000097:blood / Q000139:chemically induced / Q000628:therapy*; D010533:Peritoneal Lavage / Q000379:methods*; D009195:Peroxidase / Q000378:metabolism; D010766:Phosphorylation; D051381:Rats; D017208:Rats, Wistar; D013656:Taurocholic Acid; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D018836:Inflammation Mediators; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D013656:Taurocholic Acid; D000244:Adenosine Diphosphate; D009195:Peroxidase; D052247:Nitric Oxide Synthase Type II; D051546:Cyclooxygenase 2; D000681:Amylases; D010100:Oxygen