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World J Gastroenterol. May 7, 2010; 16(17): 2094-2099
Published online May 7, 2010. doi: 10.3748/wjg.v16.i17.2094
Acute lung injury and ARDS in acute pancreatitis: Mechanisms and potential intervention
Meng-Tao Zhou, Cheng-Shui Chen, Bi-Cheng Chen, Qi-Yu Zhang, Roland Andersson
Meng-Tao Zhou, Bi-Cheng Chen, Qi-Yu Zhang, Department of Surgery, First Affiliated Hospital, Wenzhou Medical College, Wenzhou 325000, Zhejiang Province, China
Cheng-Shui Chen, Department of Respiratory Medicine, First Affiliated Hospital, Wenzhou Medical College, Wenzhou 325000, Zhejiang Province, China
Bi-Cheng Chen, Zhejiang Provincial Top Key Discipline in Surgery, Wenzhou Key Laboratory of Surgery, Wenzhou 325000, Zhejiang Province, China
Roland Andersson, Department of Surgery, Clinical Sciences Lund, Lund University and Lund University Hospital, SE-221 85 Lund, Sweden
Author contributions: All authors equally contributed.
Correspondence to: Roland Andersson, MD, PhD, Department of Surgery, Clinical Sciences Lund, Lund University and Lund University Hospital, SE-221 85 Lund, Sweden. roland.andersson@med.lu.se
Telephone: +46-46-172359 Fax: +46-46-147298
Received: December 16, 2009
Revised: February 10, 2010
Accepted: February 17, 2010
Published online: May 7, 2010
Abstract

Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) in acute pancreatitis still represents a substantial problem, with a mortality rate in the range of 30%-40%. The present review evaluates underlying pathophysiological mechanisms in both ALI and ARDS and potential clinical implications. Several mediators and pathophysiological pathways are involved during the different phases of ALI and ARDS. The initial exudative phase is characterized by diffuse alveolar damage, microvascular injury and influx of inflammatory cells. This phase is followed by a fibro-proliferative phase with lung repair, type II pneumocyte hypoplasia and proliferation of fibroblasts. Proteases derived from polymorphonuclear neutrophils, various pro-inflammatory mediators, and phospholipases are all involved, among others. Contributing factors that promote pancreatitis-associated ALI may be found in the gut and mesenteric lymphatics. There is a lack of complete understanding of the underlying mechanisms, and by improving our knowledge, novel tools for prevention and intervention may be developed, thus contributing to improved outcome.

Keywords: Acute lung injury; Acute respiratory distress syndrome; Acute pancreatitis; Etiology; Pathophysiology