Alterations in intestinal permeability and endotoxemia in severe acute pancreatitis.

Intestinal permeability increases early in the course of acute pancreatitis and is associated with sepsis and organ failure. To evaluate the intestinal permeability (IP) and anti-endotoxin antibodies immunoglobulin G and A (AEA IgG and A) in severe acute pancreatitis (SAP) as compared to healthy controls and determine their significance in relation to various complications of SAP. IP was measured by urinary lactulose/mannitol (LM) excretion ratio and anti-endotoxin antibodies by Endocab ELISA kit at days one and seven of admission (D1 and D7). Thirty one patients of SAP [mean age (42.0 +/- 15.8) years, APACHE II scores (8.8 +/- 5.4) and CT severity index (6.4 +/- 2.0)] were included in this study. Infected pancreatic necrosis was detected in 13 (42%) patients of whom three died. Six died of persistent organ failure. Median values of LM ratio at D1 and D7 were similar to those in healthy controls. Patients experiencing complications [organ failure (4/9, 44%), infected pancreatic necrosis (5/10, 50%) and death (1/2, 50%)] manifested a substantial increase in their intestinal permeability at D7. Anti-endotoxin antibodies IgG were lower (p = 0.003) in patients than the controls at admission. AEA IgG were lower (p = 0.03) in non-survivors as compared to survivors at D7. Patients experiencing complications of severe acute pancreatitis showed an increase in intestinal permeability. Higher endotoxemia predicted poor outcome in severe acute pancreatitis.