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This damages the pancreas and disrupts pancreatic microcirculation, leading ultimately to HTG-AP. Clinically, HTG-AP is associated with increasing incidence, multiple complications, and a higher risk of severe disease or adverse outcomes. There is a lack of unified standards, both domestically and internationally, for the clinical management of HTG-AP. This presents challenges for HTG-AP treatment while also offering opportunities to explore more effective interventional approaches. Preliminary research suggests the importance of the gut microbiota in the development and progression of HTG-AP, potentially mediated by influencing lipid metabolism and inflammatory responses. However, little is known of the potential function of the gut microbiota in the etiology of HTG-AP. This review summarizes current evidence on gut microbiota alterations in HTG-AP, with emphasis on lipid metabolism, intestinal barrier injury, and immune-inflammatory pathways. 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