Chronic pancreatitis and the intestinal microbiome in adults and children: Not only SIBO but also gut dysbiosis has clinical significance

Abstract

Chronic pancreatitis is accompanied by both small intestinal bacterial overgrowth and dysbiosis of the gut microbiota. The most typical changes in the gut microbiota in chronic pancreatitis are a decrease in microbial diversity, an increase in the abundance of Proteobacteria, a decrease in the abundance of Bacteroidetes, Actinobacteria, and Firmicutes, especially butyrate-producing bacteria such as Faecalibacterium, a significant association with infectious pathways (KEGG analysis]), concomitant metabolic disorders (diabetes mellitus) and exocrine pancreatic insufficiency. Changes in the gut microbiota in children with chronic pancreatitis are like those in adults and are characterized by a decrease in α-diversity and the loss of shortchain fatty acid producers: butyrate-producing Faecalibacterium, Subdoligranulum, and Eubacterium, propionate-producing Phascolarctobacterium, acetate- and lactate-producing Collinsella, and probiotic Bifidobacterium. Dysbiotic changes in the gut microbiome, including a decrease in the abundance of commensal symbionts, are significantly associated with the severity of chronic pancreatitis. The most important factor influencing the intestinal microbiota is the pancreatic exocrine function, a decrease which leads to a switch from enterotype 1 (Bacteroides predominance) to enterotype 2 (Prevotella predominance) and a decrease in phylogenetic diversity (α-diversity index). Modulation of the dysbiotic gut microbiota can be carried out with probiotics, prebiotics, bacterial metabolites such as butyrate, pancreatic enzymes and should become a full-fledged therapeutic option in patients with chronic pancreatitis.