Authors: Attila Oláh, Tibor Belágyi, László Pótó 1, László Romics Jr2, Stig Bengmark.
Published: Pancreas 74 (594-603), 2007.
The study was conducted in vivo, involving human participants.
Design: Randomized.
Treatment: Feeding was commenced within 24 hours after admission in both groups and continued for at least seven days. The first group of patients received four different lactobacilli preparations and prebiotics containing four bioactive fibers in addition. Patients in the second (control) group received only prebiotics.
Where and when: The Surgical Department of the Petz Aladár Teaching Hospital in Gyõr between July 1st 2001 and July 1st 2004 were enrolled in the study.
Sample size: 62 patients.
Sample criteria: Patients with severe acute pancreatitis. Typical clinical picture including abdominal pain, serum amylase elevation and onset of symptoms less than 48 hours prior to admission, patients with biliary etiology. Excluded: Patients with an acute exacerbation of chronic pancreatitis.
Analysed material:
Results
Lower incidence of multiorgan failure (MOF), septic complications and mortality were detected in the first group compared to the control, but the differences were not significant statistically.
The total incidence of systemic inflammatory response syndrome (SIRS) and MOF were significantly different between the two groups (8 vs. 14).
The number of patients recovering with complications were significantly less in the first group receiving synbiotic therapy compared to the control group.
A lower rate of late organ failure was detected in the first versus the control group (3.0% vs. 17.2%). (s. 594).
A significant reduction in rate of complications is observed in the synbiotic treated group. Multiorgan failure occurred twice as often in the control group, but this difference is not statistically significant. However, when the cases of SIRS are added to the cases of MOF the difference becomes statistically significant in favor of synbiotic treatment.
Septic complications to pancreatitis occurred less than half as often in the synbiotic treated group compared to the control group (12.1% vs. 27.6%), but due to the size of material was not statistically significant.
The number of surgical interventions was also cut to half in the synbiotic treated group (12.1% vs. 24.1%).
The mortality rate was less than 1/3 in the synbiotic treated group (6.0% vs. 20.7%), but again due to the size of the difference did not reach statistical significance.
The number of surgical interventions was cut to half in the synbiotic treated group (12.1% vs. 24.1%). (s. 596).
Indicative results
The results suggest that early nasojejunal feeding with synbiotics may prevent organ dysfunctions in the late phase of severe acute pancreatitis.
The observed effects of synbiotic therapy are in line with observations made on other indications. Rayes et al. used the same formulation in a randomized study in human liver transplantation. The incidence of postoperative bacterial infections was significantly reduced; being 48% with only fibers and 3% with live LAB and fibers. In addition, the duration of antibiotic therapy was significantly shorter in the latter group. (s597).
Also, another similar study was made where the patient population was slightly smaller. The severity of disease was slightly higher in this study compared to the previous study. This study demonstrates, as the previous study, statistically significant advantages of synbiotic treatment in severe acute pancreatitis with large reduction in total number of infections and in number of infected pancreatic necroses. Both studies demonstrate improvement in rate of total complications, surgical interventions and mortality, hospital stay, ICU stay, but without reaching the level of statistical significance. Both studies suffer the disadvantages of having too small a patient population. Of that reason a meta-analysis based on both studies was made. Six different aspects were analyzed and, altogether six different aspects of synbiotic therapy were studied (s597).
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