Importance of Microcirculatory Disturbances in the Pathogenesis of Pancreatitis

Zusammenfassung

Die Kontrolle der Mikrozirkulation des Pankreas ist ein komplexer physiologischer Prozess, der noch nicht vollständig verstanden wird. Der Blutfluss im Pankreas wird bei akuter und chronischer Pankreatitis von einer Vielzahl endogener und exogener Faktoren beeinflusst. Kontrovers wird diskutiert, wie oft eine akute Pankreatitis in eine chronische Form übergehen kann. Bei der akuten Pankreatitis spielen Perfusionsstörungen und die Beeinträchtigung der mikrozirkulatorischen Integrität, die die Gewebeoxygenierung verändern, eine wesentliche Rolle bei der Progression und eventuell als primäre Ursache der Erkrankung. Endothelin und Stickstoffmonoxid sind zwei der stärksten vasoaktiven Mediatoren. Therapiestrategien zur Beeinflussung der vasoaktiven Mediatoren zeigen in experimentellen Studien positive Effekte. Bei der chronischen Pankreatitis finden sich ein verminderter Blutfluss und histologische Veränderungen in den Gefäßen sowohl bei Patienten als auch im Tiermodell. Weitere Studien müssen klären, ob Perfusionsstörungen bei der chronischen Pankreatitis eine größere Rolle bei der Entstehung oder der Progression der Entzündungsprozesse spielen.

Summary

Pancreatic microvascular control is a complex physiological process which is incompletely understood. Blood flow in the pancreas is altered by a large number of endogenous and exogenous factors in the context of acute and chronic pancreatitis. The frequency of progression from acute pancreatitis to a chronic form is a controversial question. In acute pancreatitis reductions in blood flow and alterations of microvascular integrity resulting in impaired tissue oxygenation play an important part in the progression and possibly the initiation of the disease. Endothelin and nitric oxide are believed to be two of the most effective vasoactive mediators. The beneficial effect of therapeutic strategies affecting vasoactive mediators is confirmed in experimental studies. Chronic disease is associated with decreased pancreatic blood flow and histological changes in the vasculature in both patients and animal models. Further studies are needed to clarify whether ischemia in chronic pancreatitis is more important in perpetuating the disease or as primary cause of the inflammatory processes.

Schlüsselwörter

Pankreatitis - akut - chronisch - Mikrozirkulation - Endothelin - Stickstoffmonoxid

Key words

Pancreatitis - Acute - Chronic - Microcirculation - Endothelin - Nitric oxide

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