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Therapeutic effects of rhubarb enema on Th17 cell and systemic inflammatory response in clinical acute pancreatitis
Lin-Gui Zhong, Yu Luo, Fang Gao, Ting-Ting Guo, Jian Yang, Chuan-Jiang Wang
Lin-Gui Zhong, Chuan-Jiang Wang, Department of Emergency Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
Yu Luo, Department of Outpatient, Chongqing Mental Health Center, Chongqing 400000, China
Fang Gao, Department of Science and Education, Chongqing Mental Health Center, Chongqing 400000, China
Ting-Ting Guo, Department of General Medicine, Community Health Service Center, Longmenhao Street, Nan’an District, Chongqing 400000, China
Jian Yang, Department of Gastroenterology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
Jian Yang, Department of Gastroenterology, Changdu People’s Hospital of Xizang, Changdu 854000, Tibet Autonomous Region, China
Co-first authors: Lin-Gui Zhong and Yu Luo.
Co-corresponding authors: Jian Yang and Chuan-Jiang Wang.
Author contributions: Zhong LG and Luo Y contribute equally to this study as co-first authors; Yang J and Wang CJ contribute equally to this study as co-corresponding authors; Wang CJ and Yang J performed conception hypothesis and design; Zhong LG and Luo Y performed data acquisition and analysis; Wang CJ and Gao F performed manuscript preparation; Yang J revised manuscript; Guo TT searched and collected bibliography.
Supported by Chongqing Science and Technology Foundation, No. CSTB2025NSCQ-GPX1217; 2024 Nursing Research Innovation Project of the First Affiliated Hospital of Chongqing Medical University, No. HLPY2024-10; Natural Science Foundation of Tibet Autonomous Region, No. XZ2024ZR-ZY100(Z); Program for Youth Innovation in Future Medicine, Chongqing Medical University, No. W0138; and Chongqing Key Laboratory of Development and Utilization of Genuine Medicinal Materials in the Three Gorges Reservoir Area Project, No. KFKT2022009.
Institutional review board statement: The protocol was approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University (Approval No. 2022-077).
Clinical trial registration statement: This trial has been prospectively registered on a publicly accessible clinical trial registry (Chinese Clinical Trial Registry) with the registration identifier (ChiCTR2100046548).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: There is no conflict of interest.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: No additional data are available.
Corresponding author: Chuan-Jiang Wang, PhD, Department of Emergency Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Chongqing 400000, China.
wangchuanjiang@cqmu.edu.cn
Received: December 26, 2025
Revised: February 5, 2026
Accepted: March 4, 2026
Published online: May 28, 2026
Processing time: 145 Days and 0.1 Hours
BACKGROUND
Acute pancreatitis (AP) is a common disease in the intensive care unit. Although the clinical management of AP has improved, over mortality has not declined significantly. Rhubarb, an anthraquinone glycoside derivative, has been reported to improve intestinal blood perfusion, inhibit excessive inflammatory responses, regulate inflammatory mediator cascades, and enhance intestinal motility.
AIM
To investigate the effects of rhubarb on prognosis and complications in patients with AP.
METHODS
A total of 284 patients with AP meeting the inclusion criteria will be randomly assigned in a 1:1 ratio to receive either rhubarb enema therapy or placebo (saline) for a 7-day treatment course. The primary outcome is the 28-day mortality rate. Secondary outcomes include serum levels of tumor necrosis factor-alpha (TNF-α), interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-17A, and CXCL1 measured at 1 day, 3 days, 5 days, and 7 days after hospital admission.
RESULTS
Our research results show that rhubarb enema treatment can significantly improve the systemic inflammatory response in patients with AP, and reduce the inflammatory cytokines or chemokines (e.g., TNF-α, IL-1β, IL-6, IL-8, IL-17A, and CXCL-1). Moreover, it can improve the patient’s inflammatory immune state and reduce the proportion of Th17 cells. The primary end point death failure was observed in 2 (1.39%) of 144 patients in the Rhubarb group and in 4 (2.86%) of 140 patients in the control group, with no difference in mortality or major complications between the groups.
CONCLUSION
Rhubarb enema treatment significantly reduced intra-abdominal hypertension, decreased the incidence of deep venous thrombosis, and reduced the need for intervention. These findings suggest that rhubarb enema therapy can significantly improve clinical outcomes of AP, potentially through the inhibition of inflammatory responses, thus providing a tool for anti-AP therapy.
Core Tip: Acute pancreatitis (AP) is a disease with high mortality, caused by the activation of pancreatic enzymes due to multiple factors and characterized by localized pancreatic inflammation. Pharmacological studies indicate that rhubarb significantly improves intestinal blood perfusion, suppresses excessive inflammatory responses, modulates inflammatory mediator cascades, and enhances intestinal motility. However, whether rhubarb improves the prognosis and complications in patients with AP by inhibiting Th17 cell differentiation and inflammatory responses remains unclear. Therefore, this study was conducted to evaluate the role of rhubarb in patients with AP.
