Acute pancreatitis (AP) is a digestive emergency and can develop into a systematic illness. The role of the gut in the progression and deterioration of AP has drawn much attention from researchers, and areas of interest include dysbiosis of the intestinal flora, weakened intestinal barrier function, and bacterial and endotoxin translocation. Short-chain fatty acids (SCFAs), as one of the metabolites of gut microbiota, have been proven to be depleted in AP patients. SCFAs help restore gut homeostasis by rebuilding gut flora, stabilizing the intestinal epithelial barrier, and regulating inflammation. SCFAs can also suppress systematic inflammatory responses, improve the injured pancreas, and prevent and protect other organ dysfunctions. Based on multiple beneficial effects, increasing SCFAs is an essential idea of gut protective treatment in AP. Specific strategies include the direct use of butyrate or indirect supplementation through fiber, pre/pro/synbiotics, or fecal microbiota transplantation as a promising adjective therapy to enteral nutrition.

Chronic pancreatitis is a progressive fibroinflammatory disorder with no currently satisfactory treatment. Emerging evidence suggests an association between gut microbial dysbiosis and chronic pancreatitis. Although direct causative evidence is lacking, it is hypothesized that the gut microbiota may play a pivotal role in modulating pancreatic function via the gut–pancreas axis. Thus, modulating the gut microbiota through the administration of probiotics or prebiotics may alleviate pancreatic disorders. In this review, we first propose the potential mechanisms by which specific probiotics or prebiotics may ameliorate chronic pancreatitis, including the alleviation of small intestinal bacterial overgrowth (SIBO), the facilitation of short-chain fatty acids’ (SCFAs) production, and the activation of glucagon-like peptide-1 receptors (GLP-1Rs) in the pancreas. Since there are currently no probiotics or prebiotics used for the treatment of chronic pancreatitis, we discuss research in other disease models that have used probiotics or prebiotics to modulate pancreatic endocrine and exocrine functions and prevent pancreatic fibrosis. This provides indirect evidence for their potential application in the treatment of chronic pancreatitis. We anticipate that this research will stimulate further investigation into the gut–pancreas axis and the potential therapeutic value of probiotics and prebiotics in chronic pancreatitis.

Chronic pancreatitis is a progressive fibroinflammatory disorder with no currently satisfactory treatment. Emerging evidence suggests an association between gut microbial dysbiosis and chronic pancreatitis. Although direct causative evidence is lacking, it is hypothesized that the gut microbiota may play a pivotal role in modulating pancreatic function via the gut-pancreas axis. Thus, modulating the gut microbiota through the administration of probiotics or prebiotics may alleviate pancreatic disorders. In this review, we first propose the potential mechanisms by which specific probiotics or prebiotics may ameliorate chronic pancreatitis, including the alleviation of small intestinal bacterial overgrowth (SIBO), facilitation of short-chain fatty acids (SCFAs) production, activation of the glucagon-like peptide 1 receptors (GLP-1Rs) in the pancreas. Since there are currently no probiotics or prebiotics used for the treatment of chronic pancreatitis, we have discussed research in other disease models that use probiotics or prebiotics to modulate pancreatic endocrine and exocrine functions and prevent pancreatic fibrosis. This provides indirect evidence for their potential application in the treatment of chronic pancreatitis. We anticipate that this research will stimulate further investigation into the gut-pancreas axis and the potential therapeutic value of probiotics and prebiotics in chronic pancreatitis.

Introduction: Recurrence of acute pancreatitis (AP) is common, leading to cumulative pancreatic injury and reduced quality of life. While aetiology-based treatments and lifestyle interventions are effective, long-term adherence is often poor due to insufficient health awareness and a lack of continuous reminders. We designed the PROGRESS ( PRO active GR ad E d follow-up S trategy for reducing recurrence in acute pancreatiti S ) trial to evaluate whether a physician-initiated, proactive and graded follow-up strategy can reduce AP recurrence. Methods and analysis: The PROGRESS trial is a multicentre, open-label, randomised controlled trial. A total of 194 patients with AP will be randomised 1:1 to either a proactive follow-up group or a standard follow-up group. In the proactive follow-up group, patients are stratified into high-risk or low-risk categories based on reported risk factors. Follow-up is conducted via WeChat with varying frequencies: every 3 months for the high-risk group and every 6 months for the low-risk group. The standard follow-up group receives routine discharge education and a 1-month outpatient visit. The primary endpoint is the number of AP recurrence episodes within 24 months post-discharge. Secondary endpoints include AP recurrence rate, progression to chronic pancreatitis, quality of life (Short Form 12 Health Survey), anxiety/depression scores (Generalized Anxiety Disorder-7/Patient Health Questionnaire-9), readmission rates and mortality. Analysis will follow the intention-to-treat principle. Ethics and dissemination: This study has been approved by the Ethics Committee of Peking Union Medical College Hospital (No. I-25PJ2556, I-26PJ0895). Ethics approval of each participating centre is required before initiation of patient enrolment. The results of this study will be published in peer-reviewed journals. Trial registration number: ChiCTR2500113459 (Chinese Clinical Trial Registry).