Early increase in intestinal permeability in patients with severe acute pancreatitis: Correlation with endotoxemia, organ failure, and mortality |
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Authors: | Basil J Ammori FRCS Paul C Leeder FRCS Roderick F G J King PhD G Robin Barclay PhD Iain G Martin MD FRCS Mike Larvin MD FRCS Michael J McMahon MD PhD |
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Affiliation: | (1) Academic Surgical Unit, Division of Surgery, The University of Leeds and Centre for Digestive Diseases, The General Infirmary at Leeds, Leeds;(2) Scottish National Blood Transfusion Services, The Royal Infirmary, Edinburgh, UK;(3) Leeds Institute for Minimally Invasive Therapy, Wellcome Wing, The General Infirmary at Leeds, Great George St., LS1 3EX Leeds, UK |
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Abstract: | Sepsis accounts for 80% of deaths from acute pancreatitis. This study aimed to investigate early changes in intestinal permeability
in patients with acute pancreatitis, and to correlate these changes with subsequent disease severity and endotoxemia. The
renal excretion of enterally administered polyethylene glycol (PEG) 3350 and PEG 400 was measured within 72 hours of onset
of acute pancreatitis to determine intestinal permeability. Severity was assessed on the basis of APACHE II scores and C-reactive
protein measurements. Serum endotoxin and antiendotoxin antibodies were measured on admission. Eight-five patients with acute
pancreatitis (mild in 56, severe in 29) and 25 healthy control subjects were studied. Urinary excretion of PEG 3350 (median)
was significantly greater in patients who had severe attacks (0.61%) compared to those with mild disease (0.09%) and health
control subjects (0.12%) (P <0.0001), as was the permeability index (PEG 3350/400 excretion) (P <0.00001). The permeability index was significantly greater in patients who subsequently developed multiple organ system
failure and/or died compared with other severe cases (0.16 vs. 0.04) (P = 0.0005). The excretion of PEG 3350 correlated strongly with endotoxemia (r = 0.8; P = 0.002). Early increased intestinal permeability may play an important role in the pathophysiology of severe acute pancreatitis.
Therapies that aim to restore intestinal barrier function may improve outcome.
Presented at the Thirty-Ninth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, La., May 17–20,
1998. |
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Keywords: | Pancreatitis endotoxemia intestinal permeability PEG intestinal barrier |
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