Six of the Best, Upper GI 15

Abstract

Aims: The aim of this study was to investigate whether these early changes in intestinal permeability predict outcome of the attack, and to compare that with C-reactive protein (CRP) and the APACHE II scoring system. Methods: Intestinal permeability to macromolecules (polyethylene glycol 3350) was determined within 72 h of onset of symptoms in 85 patients with acute pancreatitis. Serum CRP was measured daily, and a peak within 120 h was identified. APACHE II scores were determined at 24 h. Attacks were classified as mild (n = 57) or severe (n = 21) according to the Atlanta criteria. Results: Patients with severe attacks had significantly greater peak serum CRP levels (median: 260 mg L−1versus 93 mg L−1; P < 0.0001), intestinal permeability index (0.06 versus 0.008; P < 0.0001), and APACHE II scores (10 versus 5; P < 0.001) compared to mild attacks. The areas under the ROC curve for the prediction of severe attacks, the development of sepsis, organ failure or death, and a prolonged hospital stay were comparable between the three prognostic variables. Conclusions: Early changes in intestinal permeability to macromolecules in patients with acute pancreatitis are highly predictive of severity and outcome of the attacks, and have a predictive power that is comparable to that of the APACHE II scoring system and serum CRP. Early therapeutic interventions aimed at restoration of the gut barrier function might have a favourable impact on the course of the disease.