Журнал «Медицина неотложных состояний» Том 22, №4, 2026

Актуальність. Гострий панкреатит (ГП) є клінічно гетерогенним захворюванням; його тяжкі форми пов’язані з органною недостатністю, некрозом та інфекційними ускладненнями. Вісь «кишка — підшлункова залоза» є важливою в сучасному розумінні патогенезу ГП, оскільки дисбіоз, ушкодження кишкового бар’єра й бактеріальна транслокація можуть посилювати системне запалення та погіршувати перебіг хвороби. Мета: узагальнити сучасні дані щодо кишкової мікробіоти як терапевтичної мішені при гострому панкреатиті та оцінити клінічну цінність мікробіотних підходів. Матеріали та методи. Проведено наративний огляд з елементами критичного синтезу доказів. Пошук виконували в PubMed/MedLine, Scopus і Google Scholar; аналізували списки літератури ключових публікацій та актуальні настанови. До огляду включали клінічні дослідження, систематичні огляди й релевантні експериментальні роботи, присвячені дисбіозу, кишковому бар’єру, мікробним метаболітам і мікробіота-орієнтованим втручанням при ГП. Результати. Дані свідчать, що дисбіоз при ГП є не лише вторинним явищем, а й потенційним модифікатором тяжкості через вплив на бар’єрну функцію кишки, імунозапальні каскади та ризик інфекційних ускладнень. Оміксні та клінічні дослідження виявили зниження мікробного різноманіття, втрату бутиратпродукуючих бактерій, зростання частки умовно-патогенних таксонів і мікробіомні сигнатури тяжчого перебігу. Найбільш обґрунтованим і безпечним мікробіота-орієнтованим підходом на сьогодні є раннє ентеральне або пероральне харчування. Дані щодо пробіотиків, пребіотиків, синбіотиків і постбіотиків залишаються неоднорідними, а їх застосування при прогнозовано тяжкому або тяжкому панкреатиті потребує обережності. Фекальна та «мита» трансплантація мікробіоти є перспективними, але доказова база поки обмежена ранніми клінічними програмами та серіями випадків. Висновки. Кишкова мікробіота є перспективною терапевтичною мішенню при ГП, однак клінічне впровадження мікробіотних втручань потребує стандартизації, точнішої стратифікації пацієнтів та добре спроєктованих досліджень.

Background. Acute pancreatitis is characterized by marked clinical heterogeneity, while severe forms are associated with organ failure, necrosis, and infectious complications. The gut-pancreas axis has become increasingly important for understanding disease progression, because dysbiosis, intestinal barrier dysfunction, and bacterial translocation may amplify systemic inflammation and worsen clinical outcomes. Objective: to summarize current evidence on the gut microbiota as a therapeutic target in acute pancreatitis and to assess the clinical value of microbiota approaches. Materials and methods. A narrative review with critical evidence synthesis was performed. The literature search was conducted in PubMed/MEDLINE, Scopus, and Google Scholar, with additional manual screening of reference lists from key publications and current guidelines. Clinical studies, systematic reviews, and relevant experimental reports addressing dysbiosis, intestinal barrier dysfunction, microbial metabolites, and microbiota-oriented interventions in acute pancreatitis were analyzed. Results. Available evidence indicates that dysbiosis in acute pancreatitis is not a secondary phenomenon but can act as a modifier of disease severity through effects on intestinal barrier integrity, inflammatory signaling, and the risk of infectious complications. Clinical and multi-omics studies have demonstrated reduced microbial diversity, depletion of butyrate-producing bacteria, enrichment of opportunistic taxa, and microbiome signatures associated with more severe disease. Early oral or enteral feeding currently appears to be the most evidence-based and safest microbiota-oriented strategy because it helps preserve mucosal barrier function. In contrast, data on probiotics, prebiotics, synbiotics, and postbiotic approaches remain heterogeneous, and their use in predicted severe or severe acute pancreatitis requires caution. Fecal and washed microbiota transplantation are promising, but current evidence is still limited to early clinical experience and low-level studies. Conclusions. Gut microbiota is a promising therapeutic target in acute pancreatitis; however, clinical implementation of microbiota-oriented interventions requires standardization, more precise patient stratification, and further well-designed studies.

гострий панкреатит; кишкова мікробіота; дисбіоз; кишковий бар’єр; терапевтична мішень; огляд

acute pancreatitis; gut microbiota; dysbiosis; intestinal barrier; therapeutic target; review

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