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Interdigestive small bowel motility and duodenal bacterial overgrowth in experimental acute pancreatitis
I D Van Felius1, L M A Akkermans, K Bosscha
1Departments of Surgery and Microbiology, University Medical Center Utrecht, The Netherlands.
Abstract:
The objective of this study is to investigate the effects of an acute necrotizing pancreatitis (ANP), without biliary obstruction, on the migrating motor complex (MMC), small bowel bacterial overgrowth (SBBO), bacterial translocation (BT) and infection of the pancreas simultaneously. Rats were divided into four groups: mild pancreatitis, control, ANP and sham operated control. Jejunal myoelectrodes were used to measure MMCs. Blood, peritoneal fluid, bile, and abdominal organs were harvested for microbial culturing 72 h after induction of pancreatitis. The splenic portion of the pancreas was taken for histology. During ANP the MMC cycle length was significantly increased from 14.1 +/- 0.2 to 22.4 +/- 1.9 min (P < 0.05). The duodenum of ANP rats was in contrast with the other groups characterized by Enterobacteriacae (> 3 log 10 CFU g-1 in seven of 12 rats, P < 0.05). A positive correlation (r = 0.78, P < 0.01) existed between duodenal Gram-negative and anaerobic flora and the MMC cycle. Correlation between MMC cycle length and BT to the pancreas was positive as well (r = 0.70, P < 0.01). A positive correlation (r = 0.85, P < 0.01) was found between the severity of pancreatitis and duodenal bacterial overgrowth. During ANP without biliary obstruction, the jejunal MMC is disturbed and consequently SBBO occurs. The correlation between the severity of pancreatitis, the disturbance of the MMC and SBBO suggests an important pathophysiological role of the proximal small bowel in the infection of pancreatic necrosis.
Insights
Acute necrotizing pancreatitis (ANP) disrupts the migrating motor complex (MMC), leading to small bowel bacterial overgrowth (SBBO). This overgrowth correlates with pancreatitis severity and pancreatic infection, highlighting the small bowel's role.
Area of Science:
- Gastroenterology
- Surgical Research
- Microbiology
Background:
- Acute necrotizing pancreatitis (ANP) can lead to systemic complications.
- The role of the proximal small bowel's motility and bacterial content in ANP pathogenesis is not fully understood.
Purpose of the Study:
- To investigate the impact of ANP, without biliary obstruction, on the migrating motor complex (MMC), small bowel bacterial overgrowth (SBBO), bacterial translocation (BT), and pancreatic infection.
Main Methods:
- Rats underwent sham operation or ANP induction.
- Jejunal myoelectrodes monitored MMC.
- Microbial cultures assessed bacterial loads in various tissues and fluids.
- Histology evaluated pancreatic tissue damage.
Main Results:
- ANP significantly increased MMC cycle length (14.1 to 22.4 min).
- ANP rats exhibited duodenal Enterobacteriaceae overgrowth (SBBO).
- Positive correlations were found between duodenal flora and MMC cycle length (r=0.78), MMC cycle length and BT (r=0.70), and pancreatitis severity and SBBO (r=0.85).
Conclusions:
- ANP without biliary obstruction disrupts jejunal MMC and causes SBBO.
- The severity of pancreatitis, MMC disturbance, and SBBO are interconnected.
- Proximal small bowel dysfunction plays a significant role in the infection of pancreatic necrosis.