Document Detail


Early increase in intestinal permeability in patients with severe acute pancreatitis: correlation with endotoxemia, organ failure, and mortality.
MedLine Citation:
PMID:  10481118     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
B J Ammori; P C Leeder; R F King; G R Barclay; I G Martin; M Larvin; M J McMahon
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract     Volume:  3     ISSN:  1091-255X     ISO Abbreviation:  J. Gastrointest. Surg.     Publication Date:    1999 May-Jun
Date Detail:
Created Date:  2000-05-10     Completed Date:  2000-05-10     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9706084     Medline TA:  J Gastrointest Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  252-62     Citation Subset:  IM    
Affiliation:
Academic Surgical Unit, Division of Surgery, The University of Leeds and Centre for Digestive Diseases, The General Infirmary at Leeds, UK.
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MeSH Terms
Descriptor/Qualifier:
APACHE
Acute Disease
Adolescent
Adult
Aged
Aged, 80 and over
Antibodies / blood
C-Reactive Protein / analysis
Cause of Death
Endotoxemia / etiology*
Endotoxins / blood,  immunology
Female
Humans
Immunoglobulin G / blood
Intestines / metabolism*
Kidney / metabolism
Male
Middle Aged
Multiple Organ Failure / etiology*
Pancreatitis / blood,  classification,  complications,  metabolism*
Permeability
Polyethylene Glycols / diagnostic use,  metabolism
Sepsis / etiology
Surface-Active Agents / diagnostic use,  metabolism
Survival Rate
Chemical
Reg. No./Substance:
0/Antibodies; 0/Endotoxins; 0/Immunoglobulin G; 0/Polyethylene Glycols; 0/Surface-Active Agents; 9007-41-4/C-Reactive Protein

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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