Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial

Besselink, Marc G.; Santvoort, Hjalmar C. van; Buskens, Erik; Boermeester, Marja A.; Goor, Harry van; Timmerman, Harro M.; Nieuwenhuijs, Vincent B.; Bollen, Thomas L.; Ramshorst, Bert van; Witteman, Ben J.M.; Rosman, Camiel; Ploeg, Rutger J.; Brink, Menno A.; Schaapherder, Alexander F.; Dejong, Cornelis H. C.; Wahab, Peter J.; Laarhoven, Cees J. H. M. van; Harst, Erwin van der; Eijck, Casper H.J. van; Cuesta, Miguel A.; Akkermans, L.M.A.; Gooszen, Hein G.

doi:10.1016/s0140-6736(08)60207-x

Cited by 1,182 publications

(783 citation statements)

References 37 publications

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“…However, the efficacy of different probiotic strains may vary and a recent large RCT demonstrated that a specific probiotic product (Lactobacillus acidophilus, L. casei, L. salivarius, L. lactis, Bifidobacterium bifidum, B. lactis) may even be harmful in patients with predicted severe acute pancreatitis (46) . At the same time, a systematic review found three other trials, using different probiotics products, in patients with pancreatitis and, although none of these measured the effect on diarrhoea, there were no statistically significant increases in adverse events in the probiotic groups (47) .…”

Section: Discussionmentioning

confidence: 99%

Comparison of complications attributable to enteral and parenteral nutrition in predicted severe acute pancreatitis: a systematic review and meta-analysis

Petrov

Whelan

2010

Br J Nutr

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Enteral nutrition (EN) reduces infectious complications and mortality compared with parenteral nutrition (PN) in patients with predicted severe acute pancreatitis. However, to date the complications attributable to the administration of EN and PN in this patient group have not been comprehensively studied. The aim of the study was to systematically review the complications related to the use of nutrition in patients with predicted severe acute pancreatitis receiving EN v. PN. The Cochrane Library, MEDLINE and Scopus were searched. Randomised controlled trials (RCT) of EN v. PN in predicted severe acute pancreatitis were selected. Pooled estimates of complications were expressed as OR with corresponding 95 % CI. Data from five RCT were meta-analysed. Diarrhoea occurred in six of ninety-two (7 %) patients receiving PN and twenty-four of eighty-two (29 %) patients receiving EN (OR 0·20; 95 % CI 0·09, 0·43; P,0·001). Hyperglycaemia developed in twenty-one of ninety-two (23 %) patients receiving PN and nine of eighty-two (11 %) receiving EN (OR 2·59; 95 % CI 1·13, 5·94; P¼ 0·03). Given a significant reduction in infectious complications and mortality associated with the use of EN over PN that has been consistently demonstrated in previous studies, the former should be the treatment of choice in acute pancreatitis. Further clinical studies should investigate the strategies to mitigate the complications of enteral tube feeding in patients with acute pancreatitis.

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Section: Discussionmentioning

confidence: 99%

Comparison of complications attributable to enteral and parenteral nutrition in predicted severe acute pancreatitis: a systematic review and meta-analysis

Petrov

Whelan

2010

Br J Nutr

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“…Probiotics have been shown to reduce infectious complications by limiting small-bowel bacterial overgrowth, restoring gastrointestinal barrier function and modulating the immune system. However, a double-blind randomised trial investigating probiotics failed to reduce infectious complications in AP and was associated with increase mortality related to NOMI (PROPATRIA Trial) [15]. Probiotic prophylaxis should therefore not be administered in this category of patients.…”

Section: Surgical Treatment Of Non-occlusive Intestinal Ischaemia Andmentioning

confidence: 99%

Surgery for Acute Pancreatitis

2015

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Surgery for acute pancreatitis has undergone significant changes over the last 3 decades. A better understanding of the pathophysiology has contributed to this, but the greatest driver for change has been the rise of less invasive interventions in the fields of laparoscopy, endoscopy and radiology. Surgery has a very limited role in the diagnosis of acute pancreatitis. The most common indication for intervention in acute pancreatitis is for the treatment of complications and most notably the treatment of infected walled off necrosis. Here, the step-up approach has become established, with prior drainage (either endoscopic or percutaneous) followed by delay for maturing of the wall and then debridement by endoscopic or minimally invasive surgical methods. Open surgery is only indicated when this approach fails. Other indications for surgery in acute pancreatitis are for the treatment of acute compartment syndrome, nono c c l u s i v e i n t e s t i n a l i s c h a e m i a a n d n e c r o s i s , enterocutaneous fistulae, vascular complications and pseudocyst. Surgery also has a role in the prevention of recurrent acute pancreatitis by cholecystectomy. Despite the more restricted role, surgeons have an important contribution to make in the multidisciplinary care of patients with complicated acute pancreatitis.

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“…However, most of these previous reports did not examine the changes in the gut flora that resulted from the synbiotic therapy [1][2][3][6][7][8][9][10][11][12].…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports have described the effects of probiotics/synbiotics for general infectious complications in various patients, such as liver transplantation [1,2], major abdominal surgery [3][4][5], severe acute pancreatitis [6][7][8], trauma [9,10], and critically ill patients [11][12][13]. However, these reports generally did not examine changes in the gut flora following probiotic/synbiotic therapy [1][2][3][6][7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Synbiotic Therapy Reduces the Pathological Gram-Negative Rods Caused by an Increased Acetic Acid Concentration in the Gut

et al. 2012

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Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial

Cited by 1,182 publications

References 37 publications

Comparison of complications attributable to enteral and parenteral nutrition in predicted severe acute pancreatitis: a systematic review and meta-analysis

Comparison of complications attributable to enteral and parenteral nutrition in predicted severe acute pancreatitis: a systematic review and meta-analysis

Surgery for Acute Pancreatitis

Synbiotic Therapy Reduces the Pathological Gram-Negative Rods Caused by an Increased Acetic Acid Concentration in the Gut

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