Early Low Volume Oral Synbiotic/Prebiotic Supplemented Enteral Stimulation of the Gut in Patients with Severe Acute Pancreatitis: A Prospective Feasibility Study

Abstract

Early low volume oral synbiotic/prebiotic supplemented enteral stimulation of the gut seems to be a potentially valuable complement to the routine treatment protocol of SAP.

Use of probiotics in the treatment of severe acute pancreatitis: a systematic review and meta-analysis of randomized controlled trials

“…Of the twelve articles, six were excluded: one was a retrospective study, three articles reported results of the same study, one article did not report the outcomes of mixed cohorts with severe and mild acute pancreatitis separately and, in one article, the experimental patients received probiotic-containing enteral nutrition (EN) and control patients received parenteral nutrition (PN) but not probiotic-free EN. Thus, six RCTs were ultimately included in our present systematic review [23-28]. The blinding, randomization, random sequence generation, withdrawals and dropouts, and allocation concealment for all the trials are listed in Table 1.…”

“…The lowest daily dose of probiotics was 3 × 10 7 bacteria, and the highest dose was 8 × 10 8 bacteria. The length of treatment was reported clearly in five studies, ranging from 7 to 28 days and not reported clearly in one study [28]. In three trials, the duration of treatment was 7 days [25-27], and the duration was 14 days in one study [24] and 28 days in one trial [23].…”

“…The prediction variables for SAP varied between the trials: an Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥8 was considered as an indicator in three studies [23-25], Glasgow (Imrie) score ≥3 in four studies [23,24,26,27], C-reactive protein (CRP) level ≥150 mg/L in three studies [23,26,27] and extensive pancreatic necrosis in two studies [24,25]. In one study, SAP was predicted by APACHE II score ≥6 with systemic inflammatory response syndrome and/or organ dysfunction [28]. …”

“…Clinical trials have been conducted on the use of probiotics in AP patients at risk of developing SAP. However, disparate results were obtained from the trials; therefore, there is still no consensus about the use of probiotics in SAP [23-28], and their use is rarely recommended in clinical practice guidelines [2,29-38]. …”

“…In recent years, however, two other RCTs have been completed, with no negative consequences were in patients treated with probiotics [24,28]. We therefore consider that the results of the PROPATRIA trial are questionable and that further meta-analyses of the more recent RCTs is required.…”