Impaired small-bowel barrier integrity in the presence of lumenal pancreatic digestive enzymes leads to circulatory shock.

Shock
Erik B KistlerGeert W Schmid-Schönbein

Abstract

In bowel ischemia, impaired mucosal integrity may allow intestinal pancreatic enzyme products to become systemic and precipitate irreversible shock and death. This can be attenuated by pancreatic enzyme inhibition in the small-bowel lumen. It is unresolved, however, whether ischemically mediated mucosal disruption is the key event allowing pancreatic enzyme products systemic access and whether intestinal digestive enzyme activity in concert with increased mucosal permeability leads to shock in the absence of ischemia. To test this possibility, the small intestinal lumen of nonischemic rats was perfused for 2 h with either digestive enzymes, a mucin disruption strategy (i.e., mucolytics) designed to increase mucosal permeability, or both, and animals were observed for shock. Digestive enzymes perfused included trypsin, chymotrypsin, elastase, amylase, and lipase. Control (n = 6) and experimental animals perfused with pancreatic enzymes only (n = 6) or single enzymes (n = 3 for each of the five enzyme groups) maintained stable hemodynamics. After mucin disruption using a combination of enteral N-acetylcysteine, atropine, and increased flow rates, rats (n = 6) developed mild hypotension (P < 0.001 compared with groups perfused wit...Continue Reading

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Citations

Nov 6, 2012·American Journal of Physiology. Gastrointestinal and Liver Physiology·Jordan E FishmanEdwin A Deitch
Jan 25, 2013·Science Translational Medicine·Frank A DeLanoGeert W Schmid-Schönbein
Dec 31, 2015·Shock·Angelina E AltshulerGeert W Schmid-Schönbein
May 8, 2015·Science Translational Medicine·Benjamin D ShoganJohn C Alverdy
Oct 19, 2016·Critical Care : the Official Journal of the Critical Care Forum·Petrus R de JongNicolaas J G Jansen
Apr 20, 2017·The Journal of Trauma and Acute Care Surgery·Marco Henry SantamariaErik B Kistler
Aug 31, 2013·Annals of Biomedical Engineering·Geert W Schmid-Schönbein, Marisol Chang
Feb 12, 2017·The Journal of Small Animal Practice·T Krentz, S Allen
Aug 19, 2018·Medizinische Klinik, Intensivmedizin und Notfallmedizin·W Druml
Jan 24, 2021·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·Federico AlettiErik B Kistler
Oct 20, 2018·British Journal of Anaesthesia·J Bauzá-MartinezE de Oliveira

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