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Apoptosis

, Volume 23, Issue 7–8, pp 377–387 | Cite as

Gastrointestinal microecology: a crucial and potential target in acute pancreatitis

  • Meng-Er Cen
  • Feng Wang
  • Ying Su
  • Wang-Jun Zhang
  • Bei Sun
  • Gang WangEmail author
Review

Abstract

In the early stage of acute pancreatitis (AP), abundant cytokines induced by local pancreatic inflammation enter the bloodstream, further cause systemic inflammatory response syndrome (SIRS) by “trigger effect”, which eventually leads to multiple organ dysfunction syndrome (MODS). During SIRS and MODS, the intestinal barrier function was seriously damaged accompanied by the occurrence of gut-derived infection which forms a “second hit summit” by inflammatory overabundance. Gastrointestinal microecology, namely the biologic barrier, could be transformed into a pathogenic state, which is called microflora dysbiosis when interfered by the inflammatory stress during AP. More and more evidences indicate that gastrointestinal microflora dysbiosis plays a key role in “the second hit” induced by AP gut-derived infection. Therefore, the maintenance of gastrointestinal microecology balance is likely to provide an effective method in modulating systemic infection of AP. This article reviewed the progress of gastrointestinal microecology in AP to provide a reference for deeply understanding the pathogenic mechanisms of AP and identifying new therapeutic targets.

Keywords

Acute pancreatitis Gastrointestinal microecology Intestinal barrier Systemic inflammatory response syndrome Enteral nutrition 

Abbreviations

AP

Acute pancreatitis

SIRS

Systemic inflammatory response syndrome

MODS

Multiple organ dysfunction syndrome

SAP

Severe acute pancreatitis

GI

Gastrointestinal

PAAF

Pancreatitis-associated ascitic fluid

PPI

Proton pump inhibitor

MAP

Mild acute pancreatitis

EN

Enteral nutrition

SDD

Selective decontaminant of digestive tract

FMT

Fecal microbiota transplantation

Notes

Acknowledgements

This study was funded by the National Nature Scientific Foundation of China (Nos: 81100314, 81370565, 81770639), Nature Scientific Foundation of Heilongjiang Province (No: H201445), Wei-Han Yu scientific foundation of Harbin Medical University.

Authors contribution

M-EC, FW, and YS reviewed the current literature and drafted the main part of the manuscript. W-JZ, and BS edited the manuscript and contributed by iteratively reviewing and improving the manuscript. GW edited the manuscript, gave oversight to draft the manuscript, and made substantive intellectual contributions and improvements. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. 1.Department of Pancreatic and Biliary SurgeryThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina
  2. 2.Kidney Disease CenterThe First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhouChina
  3. 3.Key Laboratory of NephropathyHangzhouChina
  4. 4.Department of OphthalmologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina

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