Alterations in Intestinal Microbial Flora and Human Disease

Mohamed Othman; Roberto Agüero; Henry C. Lin

Disclosures

Curr Opin Gastroenterol. 2008;24(1):11-16. 

In This Article

Intestinal Motility and Gut Microflora in Acute Pancreatitis

Intestinal motility can greatly affect the intestinal microflora and acute pancreatitis provides an interesting model to understand the role of an altered gut microbiota on clinical disease. Acute pancreatitis can be induced in animals through bile duct ligation, resulting in impaired intestinal motility. The intestinal migrating myoelectric complexes that characterize interdigestive motility become inhibited.[8] Without these lumen-obliterating, sweeping contractions that propagate from the stomach or duodenum to the terminal ileum, gut microflora is no longer contained in the distal gut, resulting in SIBO.[9,10] In this example, bacterial translocation becomes a consequence of impaired intestinal motility and SIBO.[11] These findings have been substantiated in subsequent acute pancreatitis animal models not requiring bile duct ligation.[12] In fact, the occurrence of SIBO was positively correlated with the severity of the pancreatitis.[12]

Other studies of acute pancreatitis suggest that translocation of commensal gut bacteria in SIBO may be responsible for the complication of pancreatic abscess.[13] The route of bacterial translocation to the pancreas, however, remains in debate.[14] In one study, a peritoneal mode of transport was eliminated as the route to infection.[15] Other studies find an increase in intestinal permeability occurs in patients with acute pancreatitis, suggesting bacterial translocation across the intestinal barrier.[16,17] A PCR-based analysis of serum taken from acute pancreatitis patients identified DNA from Gram-negative organisms in six of 31 patients, indicating that bacterial translocation may occur in around 20% of patients with this condition.[18]

The evidence to support the use of prophylactic antibiotics in the setting of acute pancreatitis is conflicting. Whereas a Cochrane meta-analysis of five randomized control trials (RCTs) found a lower mortality rate associated with the use of prophylactic antibiotics,[19] a more recent metaanalysis of six other RCTs indicated that prophylactic antibiotics did not significantly reduce the rates of mortality, infected necrosis, or reduce the duration of hospital stay.[20] Further studies are needed to test the hypotheses that earlier antibiotic therapy targeting SIBO may be more effective in reducing complications of acute pancreatitis.

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