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Cited by 36Pancreatitis Pathology and TreatmentClinical Nutrition and GastroenterologySepsis Diagnosis and Treatment

Acute pancreatitis is characterized by generalized intestinal barrier dysfunction in early stage

Agarwal, Samagra, Goswami, Pooja, Poudel, Shekhar, Gunjan, Deepak, Singh, Namrata, Yadav, Rajni, Kumar, Umesh, Pandey, Gaurav +1 more·2023·Pancreatology
DOI 10.1016/j.pan.2022.11.011
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Abstract

Background and aims The role of intestinal-barrier in acute pancreatitis(AP) is poorly understood. We aimed to assess structural and functional changes in the intestinal-barrier in patients with early AP (time from onset<2 weeks) and the effect of enteral nutrition on them.Methods In this prospective observational study, patients with early AP not on enteral nutrition were compared with controls for baseline intestinal-permeability(lactulose: mannitol ratio(L:M)), endotoxinemia(serum IgM/IgG anti-endotoxin antibodies), bacterial-translocation(serum bacterial 16S rRNA) and duodenal epithelial tight-junction structure by immunohistochemistry(IHC) for tight-junction proteins(claudin-2,-3,-4, zonula occludens-1(ZO1), junctional adhesion molecule(JAM) and occludin) and electron microscopy. These parameters were reassessed after 2 weeks enteral feeding in a AP patients subset.Results 96 patients with AP(age: 38.0 ± 14.5 years; etiology: biliary[46.8%]/alcohol[39.6%]; severe:53.2%, mortality:11.4%) and 40 matched controls were recruited. Patients with AP had higher baseline intestinal permeability(median L:M 0.176(IQR 0.073-0.376) vs 0.049(0.024-0.075) in controls; p < 0.001) and more frequent bacteraemia(positive bacterial 16S rRNA in 24/48 AP vs 0/21 controls; p < 0.001) with trend towards higher serum endotoxinemia(median IgG anti-endotoxin 78(51.2-171.6) GMU/ml vs 51.2(26.16-79.2) in controls; p = 0.061). Claudin-2, claudin-3, ZO1 were downregulated in both duodenal crypts and villi while claudin-4 and JAM were downregulated in duodenal villi and crypts respectively. 22 AP patients reassessed after initiation of enteral nutrition showed trend towards improving intestinal permeability, serum endotoxinemia and bacteraemia, with significant improvement in claudin-2,-3 in duodenal villi.Conclusion Patients with AP have significant disturbances in intestinal barrier structure and function in first 2 weeks from onset that persist despite institution of enteral nutrition.

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  • Intestinal barrier dysfunction is an early severe complication in AP, leading to multi-organ infections and worsening disease progression.

    “Intestinal barrier dysfunction is widely acknowledged as an early severe complication in AP, leading to multi-organ infections and worsening disease progression (Agarwal et al. 2023; Wang et al. 2023).”

    From Odoribacter laneus protects intestinal barrier by bile acid-FXR axis in acute pancreatitis (2026) · cites this paper as Agarwal et al. 2023

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Authors
Agarwal, S., Goswami, P., Poudel, S., Gunjan, D., Singh, N., Yadav, R., Kumar, U., Pandey, G., & Saraya, A.
Affiliations
  • All India Institute of Medical Sciences (IN)
  • Sanjay Gandhi Post Graduate Institute of Medical Sciences (IN)
Corresponding author
Saraya, Anoop
ORCID
Venue
Pancreatology
Publisher
Elsevier BV
Published
2023-01
Volume
23
Issue
1
Pages
9-17
ISSN
1424-3903 (ISSN-L)
DOI
10.1016/j.pan.2022.11.011
OpenAlex
W4310138355
Cited by
36
References
34
Citations by year
2026: 19 · 2025: 11 · 2024: 3 · 2023: 3
FWCI
4.08
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Pancreatology (publishedVersion)
  • PubMed (publishedVersion)
Funders
Department of Biotechnology, Government of West Bengal
Topics
  • Health Sciences › Medicine › Surgery › Pancreatitis Pathology and Treatment
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
Keywords
acute pancreatitis, intestinal barrier dysfunction, intestinal permeability, enteral nutrition, bacterial translocation, endotoxemia, tight junction proteins, claudins, zonula occludens-1, duodenal epithelium, bacteremia, lactulose/mannitol ratio, anti-endotoxin antibodies
MeSH terms
Acute Disease, Adult, Humans, Immunoglobulin G, Intestinal Mucosa, Middle Aged, Pancreatitis, Permeability, RNA, Ribosomal, 16S, Bacteremia, Young Adult, Claudin-2

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