Document Detail

Intestinal microcirculation and gut permeability in acute pancreatitis: early changes and therapeutic implications.
MedLine Citation:
PMID:  10458730     Owner:  NLM     Status:  MEDLINE    
Translocation of bacteria from the intestine causes local and systemic infection in severe acute pancreatitis. Increased intestinal permeability is considered a promoter of bacterial translocation. The mechanism leading to increased gut permeability may involve impaired intestinal capillary blood flow. The aim of this study was to evaluate and correlate early changes in capillary blood flow and permeability of the colon in acute rodent pancreatitis of graded severity. Edematous pancreatitis was induced by intravenous cerulein; necrotizing pancreatitis by intravenous cerulein and intraductal glycodeoxycholic acid. Six hours after induction of pancreatitis, the permeability of the ascending colon was assessed by the Ussing chamber technique; capillary perfusion of the pancreas and colon (mucosal and subserosal) was determined by intravital microscopy. In mild pancreatitis, pancreatic capillary perfusion remained unchanged (2.13 c 0.06 vs. 1.98 +/-0.04 nl x min(-1) x cap(-1) [control]; P = NS), whereas mucosal (1.59 +/-0.03 vs. 2.28 +/-0.03 nl x min(-1) x cap((-1))[control]; P <0.01) and subserosal (2.47 +/-0.04 vs. 3.74 +/-0.05 nl x min(-1) x cap((-1))[control]; P <0.01) colonic capillary blood flow was significantly reduced. Severe pancreatitis was associated with a marked reduction in both pancreatic (1.06 +/-0.03 vs. 1.98 +/-0.04 nl x min(-1) x cap(-1) [control]; P <0. 01) and colonic (mucosal: 0.59 +/-0.01 vs. 2.28 +/-0.03 nl x min(-1) x cap((-1))[control], P <0.01; subserosal: 1.96 +/-0.05 vs. 3.74 +/-0.05 nl x min(-1) x cap(-1) [control], P <0.01) capillary perfusion. Colon permeability tended to increase with the severity of the disease (control: 147 +/-19 nmol x thr(-1) x cm(-2); mild pancreatitis: 158 +/-23 nmol x hr(-1) x cm(-2); severe pancreatitis: 181 +/-33 nmol x hr(-1) x cm(-2); P = NS). Impairment of colonic capillary perfusion correlates with the severity of pancreatitis. A decrease in capillary blood flow in the colon, even in mild pancreatitis not associated with significant protease activation and acinar cell necrosis or impairment of pancreatic capillary perfusion, suggests that colonic microcirculation is especially susceptible to inflammatory injury. There was no significant change in intestinal permeability in the early stage of pancreatitis, suggesting a window of opportunity for therapeutic interventions to prevent the later-observed increase in gut permeability, which could result in improved intestinal microcirculation.
H G Hotz; T Foitzik; J Rohweder; J D Schulzke; M Fromm; N S Runkel; H J Buhr
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract     Volume:  2     ISSN:  1091-255X     ISO Abbreviation:  J. Gastrointest. Surg.     Publication Date:    1998 Nov-Dec
Date Detail:
Created Date:  1999-10-07     Completed Date:  1999-10-07     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9706084     Medline TA:  J Gastrointest Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  518-25     Citation Subset:  IM    
Department of Surgery, Universitätsklinikum Benjamin Franklin, Freie Universität Berlin, Berlin, Germany.
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MeSH Terms
Acute Disease
Analysis of Variance
Bacterial Translocation
Capillary Permeability / physiology
Colon / blood supply*
Glycodeoxycholic Acid
Pancreas / blood supply*
Pancreatitis / microbiology,  pathology,  physiopathology*
Pancreatitis, Acute Necrotizing / microbiology,  pathology,  physiopathology*
Random Allocation
Rats, Sprague-Dawley
Video Recording
Reg. No./Substance:
17650-98-5/Caerulein; 360-65-6/Glycodeoxycholic Acid

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