Abstract
<jats:p>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.</jats:p>