Endotoxin translocation in two models of experimental acute pancreatitis

Early enteral nutrition improves intestinal barrier function in rats with severe acute pancreatitis

AIM: To investigate the effect of early enteral nutrition on the intestinal barrier function in rats with severe acute pancreatitis (SAP).

METHODS: Sixty male Sprague-Dawley rats were randomly allocated into 4 groups: a sham-operation group (n = 15), an SAP group (control group, n =15), a parenteral nutrition group (PN group, n = 15) and an enteral nutrition group (EN group, n = 15). SAP was induced by retrograde injection of 5% sodium taurocholate into the biliopancreatic duct. Rats in the sham-operation group only underwent laparotomy without induction of SAP. Six hours after surgery, rats in the former two groups were given normal saline, while those in the latter two groups were administrated with EN and PN, respectively. All rats were sacrificed 48 h after operation. Serum levels of amylase (AMS), endotoxin and diamine oxidase (DAO) were detected. Pathological changes of the pancreas were observed by light microscopy. The incidence of pancreatic abscess was calculated. The sections of terminal ileum were obtained to measure the height of villi and the thickness of the mucosa.

RESULTS: Plasma levels of endotoxin and DAO were significantly lower in the EN group than in the SAP group and PN group (endotoxin: 0.247 EU/mL ± 0.069 EU/mL vs 0.545 EU/mL ± 0.095 EU/mL, 0.333 EU/mL ± 0.046 EU/mL; P < 0.05 for the PN group, P < 0.01 for the SAP group; DAO: 0.91 EU/mL ± 0.13 EU/mL vs 1.52 U/mL ± 0.09 U/mL, 1.17 U/mL ± 0.10 U/mL; P < 0.01 for both). There were no significant differences in plasma amylase (AMS) between the SAP group, EN group and PN group (10171 U/L ± 665.77 U/L vs 9428.2 U/L ± 1076.61 U/L vs 10533 U/L ± 1669.13 U/L). The histological score of the injured pancreas in the EN group was markedly decreased in comparison with those in the SAP group and PN group (8.08 ± 1.24 vs 14.50 ± 1.05, 10.44 ± 1.01; P < 0.01 for both). The rate of pancreatic abscess in the three groups was not statistically different (SAP group: 9/15, EN group: 2/15, PN group: 6/15). Compared with the SAP group, the thickness of the mucosa and height of villi were improved obviously in both the EN group and PN group (thickness of mucosa: 226.67 µm ± 20.84 µm vs 294.79 µm ± 20.49 µm, 306.11 µm ± 24.34 µm; P < 0.01 for both; height of villi: 137.33 µm ± 9.38 µm vs 194.54 µm ± 11.96 µm, 201.72 µm ± 10.60 µm; P < 0.01 for both), although there was no significant difference between the EN group and PN group.

CONCLUSION: Early enteral nutrition can significantly improve the gut barrier function and ameliorate intestinal endotoxemia in rats with SAP.