Abstract:
The gastrointestinal tract has been implicated in the pathogenesis of acute pancreatitis. The overall aim of this thesis was to investigate the biomarkers, interventions, and clinical outcomes of gastrointestinal dysfunction in acute pancreatitis. The first study, a systematic review and meta-analysis, found that gut barrier dysfunction is present in three out of five patients with acute pancreatitis, and is not significantly affected by disease severity, timing of assessment after hospital admission, and type of test used, but does show a statistically significant association with age. A wide variety of tests have been used to assess gut barrier function, and there is a need to reach a consensus on tests used in the setting of acute pancreatitis. Further purposefully designed clinical studies are needed to further evaluate the effect of enteral nutrition on gut barrier function. The second study, a prospective cohort study, found that analgesia has a significant effect on gastrointestinal dysmotility in patients with acute pancreatitis, and opioid analgesia significantly increases gastrointestinal dysmotility compared with non-opioid analgesia. Intravenous fluids did not have a significant effect on gastrointestinal motility. Administration of an oral diet significantly improved gastrointestinal motility in comparison with oral fluids only. The third study, a prospective cohort study, investigated the role of a novel biomarker and clinical index in early prediction of clinical outcomes in acute pancreatitis. It demonstrated, for the first time, that the Gastroparesis Cardinal Symptom Index has potential for use as a predictor of oral feeding intolerance and non-mild acute pancreatitis. Ghrelin, when combined with the Gastroparesis Cardinal Symptom Index, further increased the predictive accuracy. This could assist clinicians in the nutritional management and triage of patients with acute pancreatitis. The synergistic effect of the Gastroparesis Cardinal Symptom Index and ghrelin warrants further research, and the present findings need to be confirmed in larger studies.