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World J Gastroenterol. Jun 21, 2010; 16(23): 2867-2872
Published online Jun 21, 2010. doi: 10.3748/wjg.v16.i23.2867
Inflammation and immunosuppression in severe acute pancreatitis
Marja-Leena Kylänpää, Heikki Repo, Pauli Antero Puolakkainen
Marja-Leena Kylänpää, Pauli Antero Puolakkainen, Department of Surgery, University of Helsinki, PL 340, 00029 HUS, Helsinki, Finland
Heikki Repo, Department of Bacteriology and Immunology, Haartman Institute, University of Helsinki, PL 340, 00029 HUS, Helsinki, Finland
Author contributions: Kylänpää ML, Repo H and Puolakkainen PA contributed equally to this work.
Correspondence to: Marja-Leena Kylänpää, MD, PhD, Department of Surgery, University of Helsinki, Haartmanninkatu 4, PL 340, 00029 HUS, Helsinki, Finland.
Telephone: +358-9-4711 Fax: +358-9-47174675
Received: January 24, 2010
Revised: February 11, 2010
Accepted: February 18, 2010
Published online: June 21, 2010

Acute pancreatitis (AP) is a common disease, which usually exists in its mild form. However, in a fifth of cases, the disease is severe, with local pancreatic complications or systemic organ dysfunction or both. Because the development of organ failure is the major cause of death in AP, early identification of patients likely to develop organ failure is important. AP is initiated by intracellular activation of pancreatic proenzymes and autodigestion of the pancreas. Destruction of the pancreatic parenchyma first induces an inflammatory reaction locally, but may lead to overwhelming systemic production of inflammatory mediators and early organ failure. Concomitantly, anti-inflammatory cytokines and specific cytokine inhibitors are produced. This anti-inflammatory reaction may overcompensate and inhibit the immune response, rendering the host at risk of systemic infection. At present, there is no specific treatment for AP. Increased understanding of the pathogenesis of systemic inflammation and development of organ dysfunction may provide us with drugs to ameliorate physiological disturbances.

Keywords: Acute pancreatitis, Organ failure, Inflammatory response, Immunosuppression, Coagulation