Huang SY, Zhao XW, Li QT, Ye ZX, Zhang CX. Letter to the Editor: Rhubarb enema for acute pancreatitis - encouraging gut-immune signals with unconfirmed clinical benefit. World J Gastroenterol 2026; 32(42): 123964 [DOI: 10.3748/wjg.123964]
Corresponding Author of This Article
Chun-Xiang Zhang, Dean, Professor, Department of Cardiology, The Affiliated Hospital of Southwest Medical University, No. 1 Section 1, Xianglin Road, Luzhou 646000, Sichuan Province, China. zcxteam@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
letter
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Huang SY, Zhao XW, Li QT, Ye ZX, Zhang CX. Letter to the Editor: Rhubarb enema for acute pancreatitis - encouraging gut-immune signals with unconfirmed clinical benefit. World J Gastroenterol 2026; 32(42): 123964 [DOI: 10.3748/wjg.123964]
World J Gastroenterol. Nov 14, 2026; 32(42): 123964 Published online Nov 14, 2026. doi: 10.3748/wjg.123964
Letter to the Editor: Rhubarb enema for acute pancreatitis - encouraging gut-immune signals with unconfirmed clinical benefit
Sheng-Yu Huang, Xing-Wei Zhao, Qiu-Ting Li, Zi-Xu Ye, Chun-Xiang Zhang
Sheng-Yu Huang, Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
Xing-Wei Zhao, Qiu-Ting Li, Key Laboratory of Medical Electrophysiology, Ministry of Education & Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou 646000, Sichuan Province, China
Zi-Xu Ye, Clinical Medical College, Southwest Medical University, Luzhou 646000, Sichuan Province, China
Chun-Xiang Zhang, Department of Cardiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province, China
Co-first authors: Sheng-Yu Huang and Xing-Wei Zhao.
Author contributions: Huang SY and Zhao XW contributed equally to this study as co-first authors; Zhang CX was responsible for study conception and manuscript preparation; Huang SY, Zhao XW, Li QT, and Ye ZX were responsible for manuscript preparation.
AI contribution statement: This manuscript did not use generative AI.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Corresponding author: Chun-Xiang Zhang, Dean, Professor, Department of Cardiology, The Affiliated Hospital of Southwest Medical University, No. 1 Section 1, Xianglin Road, Luzhou 646000, Sichuan Province, China. zcxteam@163.com
Received: June 2, 2026 Revised: June 27, 2026 Accepted: July 13, 2026 Published online: November 14, 2026 Processing time: 112 Days and 11.8 Hours
Abstract
Progress in acute pancreatitis management has mainly resulted from improvements in supportive care, while adjunctive therapies targeting intestinal function and immune-inflammatory responses remain unproven. In the recent issue of World Journal of Gastroenterology, Zhong et al conducted a randomized placebo-controlled trial evaluating rhubarb enema in acute pancreatitis. The intervention reduced pro-inflammatory cytokines, downregulated the Th17 cell/IL-17A pathway, increased interleukin-10 levels, and was associated with lower intra-abdominal pressure, collectively supporting the possibility that gut-directed interventions may influence systemic inflammation through modulation of the gut-immune axis. However, 28-day all-cause mortality was not significantly reduced, and the observed number of deaths was substantially lower than anticipated, reducing statistical power and increasing the risk of a type II error. Furthermore, the predominance of hypertriglyceridemic acute pancreatitis limits generalizability. Rhubarb enema should therefore be regarded as a promising but unconfirmed adjunctive intervention requiring validation in studies focused on patient-centered outcomes.
Core Tip: Rhubarb enema has shown promising intestinal-immune regulatory signals in acute pancreatitis, including a decrease in pro-inflammatory factors, a downregulation of the Th17/IL-17A pathway, an increase in IL-10, and an improvement in intra-abdominal pressure. However, recent randomized controlled studies have not shown a significant reduction in all-cause mortality at 28 days, and the actual event rate is lower than expected, with a relatively specific study population, which limits the certainty and generalizability of the conclusions. Rhubarb enema should currently be regarded as a potentially promising but unproven adjunctive intervention rather than a standard treatment that can immediately change clinical practice. Its clinical value still needs to be further verified in standardized procedures, clear stratified populations, and patient-centered hard endpoints.
