Effect of Lactobacillus plantarum enteral feeding on the gut permeability and septic complications in the patients with acute pancreatitis

Abstract

Objective: To study the effect of the Lactobacillus plantarum (LP) enteral feeding on the gut permeability and sepsis in the patients with acute pancreatitis. Subjects: Seventy-six subjects who stayed over 1 week in the hospital completed the study. Subjects were not treated with any lactobacillus supplement before the intervention. Methods: Seventy-six patients with acute pancreatitis were randomly divided into two groups, parenteral nutrition (PN) group (n ¼ 38) and ecoimmunonutrition (EIN) group supplied by LP enteral feeding (n ¼ 36). The acute physiology and chronic health evaluation score, Balthazar CT score, CRP, fecal bacterial species and DNA fingerprint profiles as well as the potentially pathologenic organisms in nasogastric aspirate were determined on the day of admission and on the 8 day. The intestinal permeability was assessed by measurement of the ratio of lactulose/rhamnose on the day of admission and on days 5 and 8. The rate of organ failure, septic complications and death cases were evaluated at the 8 day. Results: Following 7 days treatment, 38.9% patients in the EIN group were colonized with multiple organisms compared to 73.7% in the PN group (Po0.01), and 30.6% patients in the EIN grew potentially pathogenic organisms compared to 50% patients in PN group (Po0.05). The fecal bacterial DNA fingerprint profiles were less, the amount of lactobacteria and bifydobacteria decreased, and the amount of enterococci increased in PN group as compared with EIN group, Po0.05. By day 8, the lactulose/rhamnose ratio in EIN group were lower than that in PN group at days 5 and 8, Po0.05. The patients with LP got a better clinical outcomes as compared with the patients with PN. Conclusion: EIN enteral feeding can attenuate disease severity, improve the intestinal permeability and clinical outcomes.

Systematic review and meta-analysis of enteral nutrition formulations in acute pancreatitis

“…Four RCTs were not included in the above meta-analyses as they were not able to be statistically aggregated, directly or indirectly, with any other RCTs 36,43,49,50 . One RCT 49 .…”

“…Patients received (semi)elemental formulation in nine arms of the included trials 7,33,34,38,39,42,46,47,50 , polymeric formulation in seven arms 7,35,36,41,43,45,49 , fibre-enriched enteral formulation in six arms 10,37,40,44,48,49 , enteral nutrition supplemented with probiotics in four arms 10,40,48,50 , and immunonutrition (glutamine, arginine and omega-3 fatty acids) in three arms 37,43,44 . The 20 RCTs comprised a total of 1070 patients with acute pancreatitis (825 with severe and 245 with mild course of acute pancreatitis).…”

Clinical Studies Evaluating Effects of Probiotics on Parameters of Intestinal Barrier Function

“…Finally, studies were also checked for a follow-up period, to speculate on the persistence of a beneficial effect of probiotics. Only two studies specifically defined a follow-up test but neither of both tested the intestinal permeability at that time [45,46]. Although the clinical symptoms remained lower in the probiotics group, nothing can be said about the persistent effects on intestinal permeability.…”

Modulatory Effects of Gut Microbiota on the Central Nervous System: How Gut Could Play a Role in Neuropsychiatric Health and Diseases

“…For example, in experimental models of colitis, several species of probiotics including Lactobacillus, Escherichia coli, and Bifidobacterium can reduce gut permeability by upregulating trans-membrane proteins that are important in preserving tight junctions between epithelial cells. [30][31][32][33] It has also been shown that treatment with these probiotics can enhance mucus production and consequently improve the physical barrier protecting the epithelial layer. 34,35 Products of bacterial fermentation can also play an important role in maintaining the intestinal barrier.…”