The intricate interplay between acute pancreatitis and small intestinal bacterial overgrowth: Unraveling the unknown

Small intestinal bacterial overgrowth (SIBO) refers to the overcolonization of bacteria in the small intestine. Multiple studies have shown a correlation between SIBO and the occurrence and development of various diseases. This review focuses on the relationship between SIBO and acute pancreatitis (AP), summarizing the current research on the interaction and development between SIBO, AP, and gut microbiota translocation. It is emphasized that AP may lead to the generation of SIBO by prolonging the migrating motor complex (MMC) time and weakening the intestinal barrier. SIBO also plays a critical role in the development and deterioration of AP, which is related to the poor prognosis of AP through the intermediate factor of bacterial translocation (BT). Dysregulated bacteria and their metabolites can promote the occurrence of inflammatory cytokine storms through a series of immune signaling pathways. Furthermore, we summarize the promising treatments to improve AP by clearing SIBO and form a new therapeutic intervention strategy based on regulating gut microbiota and improving intestinal motility. For AP patients, rifaximin, probiotics, butyrate, and others targeting SIBO may be more effective in reducing the complications of AP and achieving better clinical outcomes, but further research is needed to validate this hypothesis.