Intestinal Barrier Dysfunction in a Randomized Trial of a Specific Probiotic Composition in Acute Pancreatitis

Besselink, Marc G.; Santvoort, Hjalmar C. van; Renooij, Willem; Smet, Martin B. de; Boermeester, Marja A.; Fischer, Kathelijn; Timmerman, Harro M.; Ali, Usama Ahmed; Cirkel, Geert A.; Bollen, Thomas L.; Ramshorst, Bert van; Schaapherder, Alexander F.; Witteman, Ben J.M.; Ploeg, Rutger J.; Goor, Harry van; Laarhoven, Cornelis J. van; Tan, Adriaan C.; Brink, Menno A.; Harst, Erwin van der; Wahab, Peter J.; Eijck, Casper H. van; Dejong, Cornelis H. C.; Erpecum, Karel J. van; Akkermans, L.M.A.; Gooszen, Hein G.

doi:10.1097/sla.0b013e3181bce5bd

Cited by 151 publications

(92 citation statements)

References 29 publications

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“…In studies using the L/M ratio an effect was not found more often than studies using other sugar tests. However, in all studies using PEG no effect was observed [17,18,53]. Interestingly in one study effects of probiotic supplementation on plasma levels of LPS were observed, despite a lacking effect as measured with PEG [53].…”

Section: Measurement Of Intestinal Permeabilitymentioning

confidence: 97%

“…Other methods were PEG and in some studies tight junction protein staining was used. IFABP or IgA/IgG were additionally measured in some studies [17,18,50] as indirect indices of the epithelial barrier integrity. CRP, TNF-α, α1-antitrypsin, mesenteric lymph nodes biopsies and PCR were often used to assess inflammatory and/or bacterial activity or translocation.…”

Section: Measurement Of Intestinal Permeabilitymentioning

confidence: 99%

“…Disadvantages are that all these methods are not very sensitive, and that they are affected by intestinal transit and the renal elimination rate [16]. Alternatively, other biomarkers for intestinal permeability are sometimes measured, like intestinal fatty acid binding protein (IFABP), C-reactive protein (CRP), tumor necrosis factor α (TNF-α), alpha1-antitrypsin, calprotectin, eosinophil cationic protein (ECP) and zonulin [17,18]. These biomarkers have been correlated with barrier function, but do not measure it directly.…”

Section: Introductionmentioning

confidence: 99%

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

Hemert¹,

Verwer²,

Schütz³

2013

AiM

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The intestinal barrier is important in preventing translocation of bacteria, toxins and antigens from the lumen of the gut into the body. Enhanced permeability, or gut leakiness, has been associated with different diseases. Probiotics can, strain-specifically, improve the epithelial barrier function. However, so far most researches have used cell lines or animal models due to the difficulty of measuring the effects of products on the epithelial barrier function in vivo in humans. Here a systematic literature search was performed to find articles addressing the effects of probiotics on the barrier function in human trials. The Pubmed database was searched (January 2013) to identify human in vivo studies with probiotic products in which parameters for epithelial barrier function were measured. In total 29 studies were identified, but patients, bacterial characteristics and methods to measure intestinal barrier function caused large heterogeneity among these studies. About half of the studies showed positive results of probiotics on the epithelial barrier function, indicating a clear potential of probiotics in this field. In a case series of 14 patients using Ecologic  825, a probiotic food supplement with known effect on epithelial barrier function, different markers of intestinal integrity improved significantly. Further studies in this field should consider strain(s), dose and duration of the probiotic supplementation as well as the markers used to measure epithelial barrier function. Besides the lactulose/mannitol test, zonulin and α1-antitrypsin might be valuable markers to measure epithelial barrier function in future experiments.

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Section: Measurement Of Intestinal Permeabilitymentioning

confidence: 97%

Section: Measurement Of Intestinal Permeabilitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Hemert¹,

Verwer²,

Schütz³

2013

AiM

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“…Although probiotics can decrease bacterial translocation in a healthy environment, paradoxically they may be associated with an increase in enterocyte damage and bacterial translocation in a patient with organ failure [65].…”

Section: Composition Of Enteral Nutritionmentioning

confidence: 99%

Evidence-based use of enteral nutrition in acute pancreatitis

Oláh

Romics

2010

Langenbecks Arch Surg

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“…It is hypothesized that infection of pancreatic necrosis is mediated by bacterial translocation from the gut, provoked by disturbed intestinal motility, bacterial overgrowth, and increased mucosal permeability [15,16,17,18,19]. Nasoenteric tube feeding is believed to stimulate intestinal motility, which may reduce bacterial overgrowth and preserve gut mucosal integrity through the stimulation of splanchnic blood flow [20,21].…”

Section: Feeding In Pancreatitismentioning

confidence: 99%

Improving the Outcome of Acute Pancreatitis

Bruno

2016

Dig Dis

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Acute pancreatitis (AP) is the most common indication for hospital admission and its incidence is rising. It has a variable prognosis, which is mainly dependent upon the development of persistent organ failure and infected necrotizing pancreatitis. In the past few years, based on large-scale multicenter randomized trials, some novel insights regarding clinical management have emerged. In patients with infected pancreatic necrosis, a step-up approach of percutaneous catheter drainage followed by necrosectomy only when the patient does not improve, reduces new-onset organ failure and prevents the need for necrosectomy in about a third of patients. A randomized pilot study comparing surgical to endoscopic necrosectomy in patients with infected necrotizing pancreatitis showed a striking reduction of the pro-inflammatory response following endoscopic necrosectomy. These promising results have recently been tested in a large multicenter randomized trial whose results are eagerly awaited. Contrary to earlier data from uncontrolled studies, a large multicenter randomized trial comparing early (within 24 h) nasoenteric tube feeding compared with an oral diet after 72 h, did not show that early nasoenteric tube feeding was superior in reducing the rate of infection or death in patients with AP at high risk for complications. Although early ERCP does not have a role in the treatment of predicted mild pancreatitis, except in the case of concomitant cholangitis, it may ameliorate the disease course in patients with predicted severe pancreatitis. Currently, a large-scale randomized study is underway and results are expected in 2017.

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Intestinal Barrier Dysfunction in a Randomized Trial of a Specific Probiotic Composition in Acute Pancreatitis

Cited by 151 publications

References 29 publications

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

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

Evidence-based use of enteral nutrition in acute pancreatitis

Improving the Outcome of Acute Pancreatitis

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