MORPHOLOGICAL AND FUNCTIONAL CHANGES OF INTESTINAL MUCOSA AT ACUTE NECROTIZING PANCREATITIS

Abstract

The purpose - to investigate the morphological and functional changes of the intestinal mucosa during acute necrotic pancreatitis and their effect on the translocation of bacteria and endotoxin. Material and methods. The conditions of the intestinal barrier were studied at 74 patients in clinics and 60 white rats in experiment during acute necrotic pancreatitis. The morphological and histological changes of the mucosal layer of the intestine, its enzyme activity, the microflora and its permeability for the endotoxin were studied. Results and discussion. During the early phase of acute necrotic pancreatitis barrier function of the intestine has been disturbed by increasing the activity of lysosomal enzymes (β-galactosidase double and N-acetyl-β-glucosaminidase triple, p <0.05), which caused the qualitative and quantitative changes of composition of glycoproteins in the epithelial layer of the mucosa shells. Disorders of the intestinal barrier were accompanied by bacterial translocation to the internal organs in 57.4% of patients who were operated early (up to 4 weeks) of the disease and in 90% of the animals after 72 hours of the experiment. High concentrations of endotoxin (over than 0.30EO/ml) delivered from the intestine have activated a specific proinflammatory cascade through the membrane receptor of monocytes/macrophages CD14, which was accompanied by the development of a systemic inflammatory response syndrome and multiple organ failure. Conclusions. During acute necrotizing pancreatitis the structure and protective function of the pre-epithelial mucosal layer are disordered, colonization of intestine by pathogenic and conditionally pathogenic gram-negative microflora is occurred which promoted migration of bacteria and transport of endotoxin into systemic blood circulation.