Gastrointestinal dysmotility in patients with acute pancreatitis

Abstract

BACKGROUND AND AIMS: Gut-origin bacterial translocation is one of the major causes of pancreatic necrotic tissue infection in patients with severe acute pancreatitis (SAP). The gastrointestinal dysmotility is supposed to be the fundamental event in this process. To test this hypothesis, alteration of colonic transit time (CTT) in patients with acute pancreatitis (AP) was investigated. In order to evaluate the possible mechanisms involved in gastrointestinal dysmotility, changes of serum motilin (MTL), cholecystokinin (CCK) and vasoactive intestinal peptide (VIP) in patients with AP were also measured. METHODS: Twenty-four non-consecutive patients with AP and 25 controls were included in this study. The diagnosis of AP was based upon clinical features, biochemical indices and radiological investigation. The severity of AP at admission was evaluated according to the APACHE-II and Balthazar computed tomography (CT) scoring system. Total and segmental CTT in patients with AP and in controls were determined by ingestion of radiopaque markers (Sitzmarks(R)) according to the modified Metcalf's method. Meanwhile, serum MTL and CCK were assessed using radioimmunoassay (RIA), and serum VIP was measured by using ELISA in this study. RESULTS: Compared to the controls, the total CTT and segmental CTT (mainly right and left hemicolon) were prolonged significantly in 10 patients with SAP and 14 patients with MAP; P < 0.05. Moreover, the total CTT and segmental CTT were markedly more delayed in patients with SAP than in patients with MAP; P < 0.05. The concentrations of serum MTL and CCK were significantly decreased in both MAP and SAP patients compared with those in controls (P < 0.01). There was no significant differences in serum MTL and CCK levels between the SAP and MAP groups; P > 0.05. In addition, the concentration of serum VIP was increased in AP patients, and it reached statistical significance in patients with SAP (P < 0.05). CONCLUSIONS: In conclusion, gastrointestinal dysmotility often occurred in patients with AP, especially more severely in SAP patients. One of the possible mechanisms might be related to the synergic actions of gut hormones, such as MTL, CCK and VIP.