Enteral nutrition in the management of acute pancreatitis: Modulates gut microbiome and alleviates inflammation

Background: Enteral nutrition (EN) represents a fundamental and efficacious therapeutic approach in acute pancreatitis (AP). Our objective is to investigate the modulation of gut microbiota through enteral nutrition. Methods: This prospective observational study enrolled 35 AP patients and implemented timely enteral nutrition intervention. Inflammatory markers, including C-reactive protein (CRP), were assessed before and after EN, while the dynamic alterations in gut microbiota were analyzed using 16S rDNA sequencing technology. Results: Following EN, CRP significantly decreased, effectively mitigating the inflammatory response. Due to inter-individual variations in post-enteral nutrition inflammatory status, patients were further stratified into H group (CRP >= 50 mg/L) and L group (CRP<50 mg/L) for subsequent analysis. Comparative evaluation of clinical characteristics between the two groups revealed that the H group exhibited a significantly higher risk of adverse prognosis including respiratory dysfunction and infectious complications. Dynamic monitoring of gut microbiota demonstrated a substantial increase in microbial diversity after EN accompanied by a decrease in opportunistic pathogens such as Enterococcus, Escherella-Shigella, and Klebsiella, along with an augmentation of beneficial bacteria including Bacteroides and Fusobacterium. The composition of gut microbiota varied according to the levels of inflammation among AP patients: Shigella predominated within Group H, while Actinomyces and Enterococcus constituted the dominant bacterial population within Group L. Furthermore, Spearman correlation analysis revealed significant associations between specific microbial communities within the gut and inflammatory markers such as neutrophil to albumin ratio (NAR) and lymphocyte to C-reactive protein ratio (LCR). Conclusions: EN can modify gut microbiota and alleviate inflammation, thereby affecting the severity and prognosis of AP patients.