Characteristics of intestinal microbiota in the pathogenesis and clinical course of acute pancreatitis

Aim. To analyze the most promising scientific and practical directions regarding the role of intestinal microbiota and its metabolites in the pathogenesis and clinical course of acute pancreatitis.

Materials and methods. The study involved a systematic literature review of the databases PubMed, EMBASE, and Cochrane for the last 20 years. A total of 5 meta-analyses, 234 clinical trials, 127 reviews, and 428 experimental studies were identified. Ultimately, 36 clinical trials, 2 reviews, and 18 experimental studies were selected for the inclusion. The systematic review was carried out in accordance with PRISMA recommendations.

Results. The structure of the intestinal microbiota significantly differs in healthy control groups and patients with acute pancreatitis. The microbiota of patients with acute pancreatitis closely correlates with systemic inflammation and intestinal barrier dysfunction. Cases of severe acute pancreatitis revealed an increase in Enterococcus, Proteobacteria, Escherichia, and Shigella, alongside a decrease in overall microbiome diversity and in Bifidobacterium, Prevotella, Faecalibacterium, Blautia, Lachnospiraceae, and Ruminococcaceae. Short-chain fatty acids, the concentration of which in the blood may indicate an increase in intestinal wall permeability, are directly involved in the pathogenesis of acute lung injury associated with acute pancreatitis.

Conclusion. Further study into the composition of the intestinal microbiota, its metabolites, and potential modulation strategies in various patient groups obtains high potential as a foundation for new diagnostic, therapeutic, and preventive approaches to acute pancreatitis.

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