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Gastrointestinal microecology: a crucial and potential target in acute pancreatitis

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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.

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Fig. 1

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

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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.

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Author notes

  1. Meng-Er Cen, Feng Wang, Ying Su and Wang-Jun Zhang contributed equally to this paper.

Authors and Affiliations

  1. Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang, China

    Meng-Er Cen, Wang-Jun Zhang, Bei Sun & Gang Wang

  2. Kidney Disease Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China

    Meng-Er Cen

  3. Key Laboratory of Nephropathy, Hangzhou, Zhejiang, China

    Meng-Er Cen

  4. Department of Ophthalmology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China

    Feng Wang & Ying Su

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  1. Meng-Er Cen
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  2. Feng Wang
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  3. Ying Su
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  4. Wang-Jun Zhang
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  5. Bei Sun
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  6. Gang Wang
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Contributions

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.

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Correspondence to Gang Wang.

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Cen, ME., Wang, F., Su, Y. et al. Gastrointestinal microecology: a crucial and potential target in acute pancreatitis. Apoptosis 23, 377–387 (2018). https://doi.org/10.1007/s10495-018-1464-9

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