[Pancreatitis and translocation--approaches for nutritional strategies]

Translocation of intestinal bacteria from the gut into pancreatic necrosis is an important factor in the development of septic complications in acute pancreatitis. Bacterial translocation is promoted by an impaired intestinal mucosal barrier, which can be attributed to the reduced oxygen and substrate supply of the intestine. A rat model of severe acute pancreatitis has been used to confirm the hypothesis that an impaired mucosal barrier can be stabilized by supplying certain nutrients, vitamins, and trace elements. A reduction in secondary pancreas infections with intestinal bacteria and improved survival was achieved under intravenous glutamine substitution, an essential amino acids in stress situations for enterocytes, colonocytes and immunocompetent cells. The positive experimental results are currently being investigated in a controlled randomized multicenter trial. Comparable studies need to be performed for verifying the effect of other nutritive factors on bacterial translocation and the disease course in acute pancreatitis.