Abstract
Pancreatic exocrine insufficiency (PEI) can be induced by various kinds of diseases, including chronic pancreatitis, acute pancreatitis, and post-pancreatectomy. The main pathogenetic mechanism of PEI involves the decline of trypsin synthesis, disorder of pancreatic fluid flow, and imbalance of secretion feedback. Animal studies have shown that PEI could induce gut bacterial overgrowth and dysbiosis, with the abundance of Lactobacillus and Bifidobacterium increasing the most, which could be partially reversed by pancreatic enzyme replacement therapy. Clinical studies have also confirmed the association between PEI and the dysbiosis of gut microbiota. Pancreatic exocrine secretions and changes in duodenal pH as well as bile salt malabsorption brought about by PEI may affect and shape the abundance and composition of gut microbiota. In turn, the gut microbiota may impact the pancreatic exocrine acinus through potential bidirectional crosstalk. Going forward, more and higher-quality studies are needed that focus on the mechanism underlying the impact of PEI on the gut microbiota.
摘要
胰腺外分泌功能不全(PEI)可由多种疾病引起,包括慢性胰腺炎、急性胰腺炎、胰腺切除术后等。PEI其主要发病机制与胰蛋白酶合成下降、胰液流动紊乱、分泌反馈失衡有关。动物研究表明:PEI可诱导肠道细菌过度生长和生态失调,其中乳杆菌和双歧杆菌的丰度增加最为多见;肠道细菌过度生长和生态失调可通过胰酶替代治疗得到部分逆转。临床研究也证实PEI与肠道菌群失调之间存在关联。胰脏外分泌水**的下降,伴随PEI产生的十二指肠pH值的改变,以及PEI引起的胆盐吸收不良,这可能是PEI导致肠道菌群丰度和组成发生改变的潜在作用机制。反之,肠道微生物群也可能通过潜在的双向调节影响胰腺外分泌腺泡的功能。展望未来,仍需要更多的高质量研究来揭示胰腺外分泌不足对肠道微生物群影响的机制。
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Acknowledgments
This work was supported by the Construction Project of Clinical Advanced Subjects of Capital Medical University (No. 1192070312), the Bei**g Municipal Science & Technology Commission (Nos. Z171100001017077 and Z191100006619038), the Capital Health Research and Development of Special (No. 2020-1-2012), and the Capital Medical University Youth Science Foundation (No. PTZ21035), China.
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Yulin GUO designed the conception, performed the study searching and interpretation, drafted the manuscript, and revised the final manuscript. Feng CAO performed the study searching and interpretation, supervised, and revised the final manuscript. Fei LI designed the conception, supervised, and revised the final manuscript. All authors have read and approved the final manuscript, and therefore, agreed to be responsible for the research integrity and for all aspects of the work.
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Guo, Y., Cao, F. & Li, F. Impacts of pancreatic exocrine insufficiency on gut microbiota. J. Zhejiang Univ. Sci. B 25, 271–279 (2024). https://doi.org/10.1631/jzus.B2300070
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DOI: https://doi.org/10.1631/jzus.B2300070